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Your Anxiety Toolkit - Anxiety & OCD Strategies for Everyday

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Now displaying: February, 2023
Feb 24, 2023

Depression is a liar. If you have depression, the chances are, it’s lying to you too. 

Depression is a very, very common mental health disorder, and it tends to be a very effective liar. My hope today is to get you to see the ways that it lies to you—the ways in which depression lies to you, and gets you to believe things that are not true. 



I believe that this part of depression, this component of managing depression is so important because the way in which depression lies to us, impacts how we see ourselves in the world, how we see the future, how we see other people, how we see our lives playing out. And that in and of itself can be devastating. 

Today, I want to talk about, number one, the ways in which depression lies to us and what we can do to manage that. Let’s get going. 

THEMES OF DEPRESSION

Before we start, let’s talk about the themes of depression. Now, the way it was trained to me is that there are three core themes of depression. The first one being hopelessness, the second one being helplessness, and the third being worthlessness. It will often target one, some, or all of these themes. Let’s go through those here and break it down. 

325 Depression is a Liar

DEPRESSION LIES ABOUT THE FUTURE

This is where it can really make us feel very hopeless. Depression says your future won’t be good. You won’t amount to anything. You won’t be successful. You won’t have a relationship if that’s important to you. You won’t have kids if that’s important to you. It often will target the things that we deeply value and it’ll tell us you won’t get those things or you’ll be doing those things wrong. Or in some ways, something bad will happen. When it targets the future, that is often when we begin to feel very hopeless. When we think about the way the human brain works, our brain does things right now, even things it doesn’t want to do, knowing that it’ll get a benefit or a payoff or a wonderful, joyful result. But if your brain is telling you that the result is always going to be bad, that’s going to create an experience where you feel like there’s no point. What’s the point of doing this hard thing if my depression is telling me the future is going to be crummy anyway? What we want to do is get very skilled at catching it in its lies about the future. 

DEPRESSION LIES ABOUT THE PAST

Depression will tell you, you did something wrong. You’re terrible. That thing you did really ruined your life or ruined somebody else’s life, or is proof that you’re a bad person. Depression loves to ruminate on that specific event or an array of events. What we end up doing is cycling and gathering evidence. This is what depression does. It gathers evidence to back its point. What we end up doing is instead of seeing the event for what it is, which is both probably positive and negative, depression likes to magnify all of the things that you did wrong or that didn’t go well. And then it wants to disqualify the positive. Often patients of mine with depression will say, “Oh, I’m a terrible person. I did this terrible thing,” or “I made this terrible mistake or accident.” I’ll look and say, “Okay, but what about the other times where maybe you didn’t make a mistake and so forth?” They will disqualify that as if it means nothing to them. It does mean something to them, but often the way in fact depression functions is it keeps you looking at the negative. And that’s how you get stuck in that cycle of rumination on the negative—feeling worse and worse, feeling more shame, feeling more guilt, feeling more dread, feeling often numb because the depression is so, so strong. 

Now, this is where I’m going to offer to you to reframe things a little bit and look at helplessness. Depression will also tell us: “There is no one who can help you. There is no amount of support that can help you. You’re helpless.” Often when people come to me for their first time in session, they will say, “I’m here. I understand you can help me. But at the end of the day, I don’t even think you can help me.” Maybe they’ve read one of my articles on the internet or they’ve listened to a podcast and they go, “You’re speaking to exactly what I’m going through, but I still don’t even believe you can help me.” This is where I can give them all the science and show them that I can help them and that there’s treatment for depression, and it’s very science-based. The depression will still lie to them and say, “There’s no point. You’re helpless.”

Now, the last piece here is about worth, and I’ll touch on that here in just a little bit. Before we move into that, I want to share with you that the reason I was so excited to talk about this with you today is I’m in the process of creating a course for OCD. I’m contributing this to a bigger company and I will be creating it. You guys can have access to it too here very soon. As I was creating it, I was really starting to see and talk to a lot of people with depression and talk to people on social media. The biggest message people were saying is, “OCD lies to me. It tells me these things. My friends, my loved ones tell me that that can’t possibly be true. They don’t see any of these negative things, but to me, it feels so true.” I wanted to let you know that we do have an online course for depression. You can go to CBTSchool.com/depression to hear more about it. 

DEPRESSION LIES ABOUT YOUR WORTH. 

Remember, one of the themes of depression is worthlessness. What it does there is it tells you, you are bad. Now, we know this can be the voice of shame, but depression and shame go very well together. In fact, they can have a whole party together if we let it go on for too long, telling you, you are bad, there is something innately wrong with you. This is a lie depression will tell you over and over again. When I say it’s a lie, believe me, it is a lie. This is what I always will say with my patients—if we went to a court, we put it up with the jury and we said, “This person would like to claim that they are worthless.” Then the jury is going to say, “Where is your evidence?” We’re not really going to put you up in front of a jury. I don’t want that to frighten you. But if we were, they would say, “Show me the evidence.” Then the attorney would bring in all of the evidence of the facts that you’re a wonderful person, that you’re innately worthy, that you do these kind things, that you deeply care about other people, that you’re a human being, and just being a human being means you’re worthy. We would have all these people come in and bring evidence, but the person with depression, their OCD will gently or very meanly whisper in their ear, “That’s not true,” despite all the evidence. 

Now we know if this was an actual court case, the judge would throw this case out. They’d go, “There is a profound degree of evidence that this person is worthy. There is a profound degree of evidence that this person can rebuild their life and get their life back on track even if they’re really struggling and functioning with depression.” We know this to be true. I’ve seen it every day in my practice. I’ve seen people with depression manage it and go on to live wonderfully fulfilling lives. 

For you, I want you to keep that imagery in your mind, of that jury throwing your case out and that judge throwing your case out because the evidence does not support depression’s case. It wouldn’t last a second in court. Again, a lot of the points I made there are really important if you’re struggling with worthlessness. You being a human being makes you innately worthy. You’re not worthy one day because you did well on an exam but not worthy the next day because you crashed your car. It doesn’t work like that. We’re all worthy. So we have to remember that and keep that in the front of our mind, even if depression has a lot to say about that. 

DEPRESSION LIES ABOUT WHO YOU ARE 

Depression—not only does it lie about your future, not only does it lie about your past, not only does it lie about your worth, it lies about you in general.

Your job and my job as a therapist is to help our minds. My job as a human, I should say, is to help our minds by being able to observe and be aware of our thoughts and catch when it’s in the trend of these areas—worthlessness, hopelessness, and helplessness. If it’s got any theme of those and it’s very strong and very black and white, chances are, it’s depression. We can then work and get tools to manage that. 

OVERCOMING DEPRESSION

Now, as I said, I do have an online course because a lot of you will not be able to have therapy with me. First of all, I’m always going to encourage you, go and see a therapist if you can if you have depression. Over any course I could ever offer you, I would always encourage you to first see if you can get access to a mental health therapist. However, if you don’t have access to that, you can go to the course to get some tools, strategies, and depression tips that you could be practicing. We go through and look at changing your thoughts. We go through changing your behaviors, looking at your activity schedule, looking at motivation. We look at a lot of that, but that is not therapy. The course is not therapy. It is not a specific depression treatment. But I will teach you everything that I tell my patients in my office.

DEPRESSION TIPS & DEPRESSION TOOLS 

Now, before we end this, I want to first go through some depression tips & depression tools that I want to send you off with today so that you can get started right away. I really believe Your Anxiety Toolkit is all about giving as many anxiety and depression tips, tools and helpful skills as we can, so I want to send you away with some bite-size ideas on that you can start immediately. 

Tip #1: Start a self-compassion practice

The biggest thing that depression does is it bullies us. It says horrible, mean things that you would never say to not only a loved one, even someone you hate. You probably wouldn’t say as many mean things as depression has to say. Number one, start with a self-compassion and mindfulness practice. A part of your self-compassion practice is talking back to depression. Now remember, self-compassion is nurturing, it’s kind, but it also doesn’t set back and let people push you around. Self-compassion would never have you be bullied. If you were in a compassionate place and you saw someone else being bullied, chances are, you’d step in and say, “Hey, this isn’t right,” or you’d call someone who could come and assist them. Now, this goes for depression as well. 

Here I want you to remember, if depression is bullying you and telling you lies, you’re going to have to talk back to it. I will say, I do not mind if you swear. I do not mind if you have to get a little aggressive with it. I will share with you personally the most common depressive thought that I have, and I have it a lot—you cannot handle this. I hear it many times in the day. In fact, now it almost makes me laugh a little bit because it’s very boring. Depression needs to come up with some new jokes because this is the one it uses with me all the time. Often when it says that, no longer do I believe it and agree with it and go ahead and listen to what it has to say. Now, I come back with evidence and say, “You know what? I can handle it because I’ve handled it before. In fact, I’ve handled much worse than this. So depression, you can go and do whatever it is that you need to do, but you don’t get to bully me anymore.”

Some people find that it’s better to absolutely swear the biggest profanity and say, “FU, depression. Back off! You know nothing about me and you know nothing about my future and know nothing about my past, and I’m going to politely ask you to sit down because I got this.” You can talk to depression in whatever way is helpful to you as long as you’re talking to it as separate, not to you in the way where you’re saying and swearing at yourself. 

Now we also know there is some evidence that you can use your name by saying, “No, Kimberley can handle this. Thank you, depression.” Using the third person, we’ve got research and science to show that that is very empowering. I could say to depression, “Thank you, depression, but Kimberley has got this. She is going to do her best. She’s going to put one foot forward and please sit down because you don’t get to tell her what to do today.” That is how we can talk back to depression. 

Tip #2: Keep your expectations small

I know when you’re suffering and you’re starting to lose your functioning and depression is taking a lot from you. It’s taken your friendships, your time, taking you away from events. It’s made you miss being present with your children or your family or your loved ones. I know what it can feel like in that you feel like you have to catch up somehow. What I want to offer to you is, yes, I know you want to catch up, but the only way to catch up is to do baby steps. Please don’t try and push yourself with pressure to catch up at a rate where it doesn’t help you. In fact, when we put a lot of pressure on ourselves, we actually create a lot more depression because it feels scary, it feels more overwhelming, which your depression is already done to you.

What I want you to do is make small, realistic expectations for the day and work at keeping the expectations small and then build on them. As you do something that was just baby steps, your depression is going to say, “See, what a loser? You’re doing only small steps? You should be doing big steps.” This is where you’re going to go back and talk to depression and say, “Back off! I’m doing what I need to do today to take you over. I’m taking you down, depression, and I’m going to do it slowly and compassionately. It will work because I’m building habit upon habit, not just pushing myself out of self-punishment and self-judgment, and self-criticism.” We know that those behaviors make depression worse, so we’re actually going to cheer ourselves on. 

Tip #3 Celebrate your wins

That is the big piece that we need to remember. The best way to change the mindset over depression is to be kind and to cheer ourselves on, to motivate ourselves, to celebrate when you make a baby step. I celebrate you if you’re making baby steps. Even listening to this right now, I celebrate you. You’re investing in your well-being. We want to make sure we’re cheering you on. I call it the kind coach. It’s the voice that says, “You can do it. Just a little more. Keep going. I believe in you. Just a little more. What would be right for you? What do you need?” It takes into consideration that, of course, you’re going to have challenges. But when you have challenges, it’s there to say, “What can we do to strategize? Maybe we need to rethink this. How can we rethink this in a way that makes it possible for you just to get back on track?” Baby steps at a time.

I hope that was helpful. I really wanted to go over and really reinforce to you and hopefully get you to see that depression is a wire and depression is lying to you. A big part of that is you recognizing and being aware and observing and catching when it lies to you and having skills so that you can talk back to it, change the way you respond so that you’re not contributing and making the depression stronger. 

Have a wonderful day. You guys always know, I’m always going to say it is a beautiful day to do hard things. I hope that this was helpful and I hope you have a wonderful day.

Feb 17, 2023

Transcript

Kimberley Quinlan: Well welcome, I cannot believe this is so exciting. I've been looking forward to this episode all week. We have the amazing. Reverend Katie O’Dunne with us to talk all about scrupulosity and religious obsessions. So welcome, Katie.



Treating Scrupulosity and Religious OCD with compassion (with Katie O’Dunne)

Katie O'Dunne: Thank you. I'm so excited to be here and to chat about all things Faith and OCD. So thanks for having me.

Kimberley Quinlan: Yeah, so let me just quickly share in ERP school we have these underneath every training, every video. There's a little question and answer and I'm very confident in answering them, but when it comes to the specifics of religion, I always try to refer to someone who is, like an expert. And so this is so timely because I feel like you are perfect to answer some of these questions. Some of the questions we have here are from, ERP school. A lot of them are from social media and so I'm so excited to chat with you. 

Katie O'Dunne: Thank you.

Kimberley Quinlan: So tell us before we get into the questions, a little about your story and you know why you are here today?

Katie O'Dunne:  Yeah. So I've navigated OCD since before I can remember, but just like maybe a lot of folks listening. I was very private about that for a very long time. I had a lot of shame around, intrusive thoughts. I had a lot of shame around religious obsessions that I had, moral related obsessions, harm obsessions. And this shame particularly came because I was pursuing ministry and OCD really spiked in the midst of me going to graduate school, going to seminary. And when I was in seminary and I started really struggling, I wanted to seek treatment for the first time and was told really by a mentor that it would not help me to do that. In my ministry that I wouldn't pass my psych evaluations and that I shouldn't pursue treatment that I needed to keep that on the down low. So as many of us know, that might not get that effective evidence-based treatment I continued to get sicker

Katie O'Dunne: And had a really pretty full-blown OCD episode in my first role in ministry.

Katie O'Dunne: So I ended up in school chaplaincy working, with lots of students from different faith backgrounds, some of what we'll be talking about today, through an OCD lens. And I was trying to keep my OCD a secret, but in the midst of navigating, some difficult tragedies and traumas with students, my OCD latched on to every aspect of what I was navigating. And particularly in the midst of that, I was experiencing losses and mental health crises with students from different faith backgrounds. And when I came out of my own treatment, where exposure and response prevention, very much saved my life. I felt like, I had an obligation to those students that I worked with to let them know that their chaplain, that their faith leader had gone through mental health treatment and that there was no shame around doing that. And I went from the space, in seminary of being told that I shouldn't seek treatment to a space of having families call me for the first time and say, Oh now we can actually talk to you about what's going on in our life. Can you help us talk with our rabbi or our imam, or our priest about my child's diagnosis? How can we reconcile faith with treatment and that opened the door for me to continue this work in a full-time way. Where moving from those students that I love so much and  now work in the area of faith and OCD full-time helping folks, navigate religious scrupulosity and very much lean into evidence-based treatment while also reconnecting with their faith in ways that are value driven to them and not dictated by OCD.

Kimberley Quinlan: Hmm, it makes me teary. Just to hear you say  that folks were saying, Well, now, I can share with you. That is so interesting to me. You know, I think of a reverend, as like, you can go to them with anything, you know, and for them to say that you're disclosing has open some doors, that's incredible.

Katie O'Dunne: And particularly, I worked really heavily with my Hindu and Muslim students. And we had the chance to do some really awesome mental health initiatives for the South Asian community, where students started then doing projects actually in their own faith communities, and opening up about their own journeys, and then giving other space to do the same. And I really, I think about the work I do now, which is very much across faith traditions around OCD. And every person I work with, I think of those awesomely brave students, who started to come to me after my disclosure and say, Okay, we want help and also we want to share our stories and continues to inspire me.

DOES RELIGIOUS OCD/SCRUPULOSITY SHOW UP BEYOND THE CHRISTIAN RELIGION? 

Kimberley Quinlan: Yeah, so cool!  It leads me to my first question which is, does this for OCD religious scrupulosity, have you found, and I  definitely have,  that It goes outside of just the Christian religion. I know we hear a lot about just the Christian religion, but can you kind of give me your experience with some other religions you've had to work with?

00:05:00

Katie O'Dunne: Yeah. And so I always tell folks OCD is OCD, is OCD. And it always loves to latch on to those things that are the most significant and important to us. So it makes a lot of sense, that, that would happen with our faith tradition, whether you're Christian or Muslim or Buddhist or Sheik, or beyond or even atheist or agnostic can really transform into anything, particularly from what, you might be hearing from faith leaders and I always go back to this idea that OCD is just really gross ice cream with a lot of different gross flavors and those flavors might be in the form of the Christian faith or in the Jewish faith or in the Muslim faith. But the really big commonalities is the fact that it's not about what a person actually believes just like, with everything else with OCD. This is very much egoistonic. It's taking their beliefs. It's twisting them and it's actually pushing them further away from the tradition. So, it's just some examples.

Katie O'Dunne:  That we see, of course, in Christianity, you all might be familiar with obsessions around committing blasphemy against the Holy Spirit, or fear of going to hell or fear of sinning in some way. But we also see lots of different things in Islam, whether that's around not being fully focused during Friday prayers or not doing ritual washing in the appropriate way. In Judaism we see so many different things around dietary restrictions or breaking religious law. What if I'm not praying correctly? Hinduism, even what if I'm pronouncing shlokas or mantras incorrectly? What if I have done something to impact my karma or my dharma? What if I'm focusing too heavily on a particular deity or not engaging in puja correctly. or in Buddhism I see a lot of folks, really focusing on what if I never stop suffering, What if I've impacted my karma in some way? What if I don't have pure intention, alongside that action and…

Kimberley Quinlan: Right.

Katie O'Dunne: then all the way on the other side. We can see with any type of non-theism or atheism, agnosticism humanism What if I believe the wrong thing? What if I'm supposed to believe in God, what if I'll be punished for for not? So there are all different forms and then with any faith, tradition. I mean any form possible. That OCD could latch onto

Kimberley Quinlan: Yeah, absolutely I think there's just some amazing examples I had once a client who felt his frustrations weren't correct.

Katie O'Dunne:  Yes.

Kimberley Quinlan: And got stuck really continue and trying to perfect it so I think it can fall into any of those religions for sure. So you've already touched on this a little bit, but this was one of the questions that came from Instagram. Just basically there was saying like OCD makes me doubt my faith. Like why does it do that? Do you have any thoughts, on a specifically why OCD can make us doubt our faith?

Katie O'Dunne: Yeah. I mean OCD is the doubting disorder and we always say the content is irrelevant, but it definitely doesn't feel like it. I think for anybody navigating OCD, you're most likely in a space of saying I could accept uncertainty about any theme except the one that I have right now and that's very much true with faith. If your faith is something that's significant to you and at the center of your life, it makes sense that OCD would latch on to that and that OCD would twist that particularly…

Kimberley Quinlan:  Right.

Katie O'Dunne: because we really don't have a whole lot of certainty around faith to begin with and where there's a disorder that surrounds uncertainty and and doubt. That makes a lot of sense. And yet it's so so challenging, um, because we want to be able to answer all of these questions without OCD making us question every single thing we believe,

WHEN OCD DOUBTS MY FAITH

Kimberley Quinlan: Mmm. It's sort of like religious obsession. I mean relationship obsessions too in that and you're probably looking at people across the your religious faith hall or wherever going, but they are certain like why can't I get that certainty? Right. But it's like they've accepted a degree of uncertainty for them to feel certain in it. But when you have OCD, it's so hard to accept that uncertainty piece of it.

Katie O'Dunne: I'm so glad you said that I actually get this question a lot. And this, this might be a strange answer for folks to hear from a minister. But I always tell folks, I'm not certain I Have devoted my life to faith traditions. I'm ordained. I'm not certain about anything including about the divine.

Kimberley Quinlan: Yeah.

Katie O'Dunne: I have really strong beliefs, I have strong things that I lead lean into and practices that are meaningful to me. But it doesn't mean that I have certainty. And often, when you hear someone in a faith tradition, say that there are certain, I don't think it means the same thing as what we're thinking, it means from.

00:10:00

Kimberley Quinlan: Yeah. it's Yeah,…

Katie O'Dunne: a different context. They are accepting some level of uncertainty.

Kimberley Quinlan: that's why I compared it to relationship OCD, You're like, but I'm not sure if I love my partner enough and everybody else is really certain but when you really ask them, they're like, No I'm not completely certain,…

Katie O'Dunne: Yeah.

WILL GOD PUNISH ME FOR MY INTRUSIVE THOUGHTS?

Kimberley Quinlan: like I'm just certain for today or whatever it may be. So I think that that is very much a typical trade of OCD in that, it requires 100%, okay? So, so, This is actually really one of the first common questions we get when we're doing psychoeducation with clients. Which is why do I have a fear that God will punish me for my intrusive thoughts? You want to share a little about that.

Katie O'Dunne: Yeah, I mean there are so many, there are so many layers with this and again, latching on to what's the most important but also latching on to particular teachings. Whether it's in a church or a mosque or a synagogue where I always say there are particular scriptures, particular, teachings, particular sermons, where you might hear things that relate to punishment in some way, or relate to rigidity, but I think folks, with OCD hear those, through a very different lens than maybe someone else in that congregation and we might hear something once at age, five or six and for the rest of our lives latch on to this idea that we're doing something wrong or that God is going to punish us, we tend to always see everything through that really, really negative lens and maybe miss all of the other things that we hear about compassion and about love and forgiveness. And I think there's also this layer for individuals with OCD often holding themselves to a higher standard than everyone else and that includes the way that they see God as viewing them. So I'll often ask folks. How do you think, how do you imagine God, viewing a friend in the situation? Just like we might do a self compassion work and they're like, Well, I believe God would be really forgiving of my friend and that they might not be perfect but that they were created to live this beautiful life. And then when asking the same thing about themselves, It's but God called me to be perfect and I have to do all of these things right. I'll ask often ask folks, What does it look like to see yourself through the same loving eyes through which God sees you or which you imagine that God sees those around you which is something we don't often do with OCD.

Kimberley Quinlan: And what would they often say?

Katie O'Dunne: Ah well it's so I'll actually use self-compassion practices to to turn things around. And I'll say I'll ask someone to name three kind things about themselves and then to put their hand over their heart and actually say it through the lens of God saying that to them. So I'll have them say something like The Divine created me to be compassionate, the Divine believes that I am a kind person, the Divine wants me to have this beautiful life and to be a good runner or a good baseball player or whatever that is. And it's always really difficult at the beginning just like any self-compassion practice. And then I'll watch folks start to smile and say Well maybe God does see me in that way.

Kimberley Quinlan: That's lovely.

Katie O'Dunne: Maybe create me in a beautiful way.

DO NOT FEAR…SHOULD I TURN MY FEARS OVER TO GOD?

Kimberley Quinlan: Mmm. That's what it's bringing them. Back to their religion and their faith when they do that, which is so beautiful, isn't it? Mmm. Okay, This question is very similar but I really think it was important to to address is there are some scriptures where people here that they aren't allowed to fear or that they must turn their fears over to God. Do you have any thoughts or you know, responses that you would typically use for that concern?

Katie O'Dunne: Mm-hmm.

Katie O'Dunne:  Yeah, I think, you know, it looks very different across faith traditions and across scriptures and individuals, of course, view Scripture and in very different ways but depending on their denomination, or depending on their sect, but I think sometimes, unfortunately, those scriptures are used out of context. We see this often where there might be a particular verse that's pulled that from a translation perspective isn't necessarily really about anxiety in the same way that we're defining anxiety through an OCD lens or isn't really about intrusive thoughts, in the way that we're defining it through the lens of OCD. And I think it's really unfortunate when we hear religious leaders or folks in communities say, Well, you aren't allowed to fear or if you just prayed a little bit harder, your anxieties would be able to be turned over to God. And I think we're hearing that or they're using that and maybe a different way than the passage was intended. And then we're hearing this through a whole nother another layer where it actually could be flipped. And instead, when you're you're saying, Don't fear. I always tell folks. So what does it look like instead to not fear treatment or to do it  even if you're afraid. To ask God, to give you strength in the midst of that fear  and to approach that in a different way. But I think sometimes those who are taking particular passages out of context, might not fully understand the weight of OCD, or what comes with that condition.

00:15:00

HOW DO I KNOW IF IT IS OCD OR IN LINE WITH THE RULES OF MY FAITH?

Kimberley Quinlan: Right. Right. I love that. Thank you for sharing. That was actually the most common question, I think. So like four or five people off the same question. So I know that's a such an important question that we addressed. Quite a few people also asked how to differentiate like, you know with OCD treatment, it's about sort of understanding and being aware of when OCD is present and how it plays its games, and it's tricks in its tools that it uses. How would people know whether something is OCD or actually in line with the rules of their faith? Do you have any sort of suggestions for people who are struggling with that?

Katie O'Dunne:  Yeah, so I'll actually often show folks a chart when we start to work together and we'll put things in different buckets of what are things that you're doing, because they are meaningful because they bring you hope because they bring you comfort because they bring you joy. And then on the other hand, What are things that you're doing out of fear? Out of anxiety things, that feel urgent things that are really uncomfortable. And of course, there is never any certainty around anything, which is very much one of the tricky parts with with treatment, right? We want to have certainty but I invite folks to really make the assumption that probably those things that bring joy and meaning and hope and passion and connection are the authentic versions of their faith. Versus the things that we're doing out of fear or anxiety. And, you know, I was doing a training, a couple months ago for clinicians in this area and I was, I was talking about how, you know, we don't necessarily want folks to pray out a fear and someone had a really great question. They said. Okay. But if a plane is going down and someone's praying because they're afraid like that's not because it's OCD, I'm like No that's that's very true. But in that situation they are praying because they're afraid to bring meaning and hope they're not praying because they're afraid of not praying and…

Kimberley Quinlan: Yeah.

Katie O'Dunne: there's a very big distinction there. Are you doing the practice? Because you're afraid of not doing it or not or you're afraid of not doing it perfectly, or are you engaging in that practice even in moments that are tough in order to bring you peace and meaning and joy and comfort.

WHEN PRAYER BECOMES A COMPULSION 

Kimberley Quinlan:  And that if that, maybe I've got this wrong so please check me on this, but it feels like too, when people often ask me that similar question but not around compulsive praying of like, but if there is a problem, shouldn't I actually do something about it? And I'm like, Well, this that's a difference between doing something about something when there is an actual problem compared to doing something because maybe something might happen in the future, right? It's such a trick that OCD plays. Is it gets you to do things just in case. So would that be true of that as well?

Katie O'Dunne: Okay. Yeah. And I often tell folks just again because it's just another form of OCD that's latching on to something that significant very similar. I tell folks, if it's really a problem that you need to address, most likely you would do it without asking the question to begin with. But it's I think the unfortunate thing that the other example I give is well, if we think most traditions we think of God as a parent figure and I ask folks, who are our parents to imagine their relationship with their own child, and do you want your child to connect with you throughout the day out of meaning and out of hope and out of genuine, a genuine desire for love or because they're afraid of not talking to you and…

Kimberley Quinlan: Right.

Katie O'Dunne: those are two. Those are two very, very different things.

Kimberley Quinlan:  Right. As it's like a disciplinarian figure. Yeah, that's a really great example. I love that. Yeah. Okay. This is, this was one of the questions that I got, but it's actually one of the cases that I have had in my career, as well, which is around the belief that thoughts are equal to deeds, right? Like that. If I think it, it must mean, I love it, I like it, or I want it or I've done it. Can you give some perspective to that from from specifically related to religious obsessions?

Katie O'Dunne: 

00:20:00

Katie O'DunneYeah this can be really hard for folks and of course with OCD thought actions fusion can be really challenging anyway and there is often, for folks in a faith context this belief that because I had this though, because I had what might be perceived as a sinful thought, I must be committing blasphemy, or I must be committing this particular sin and that can make it really really tought to do diffusion work with you clinician because its like I had this thought it must actually mean that I have done this thing that is in opposition to God and I always tell folks that of course I am not going to reassure you fully that those things are completely separate but I would invite you to lean into the possibility that a thought is just a thought. Just like any other aspect of OCD we have a jillion different thoughts a day that pass into and out of our minds and I actually think from a faith perspective that it is pretty cool that our brains produce alot of different thoughts, that we see things and make different associations. Ill tell folks way to do God we see things and make all sorts of connections. But, having thought doesn't equate to having a particular action even if we are looking on the form of most scriptures. It is really referencing things that we are doing, ways that we are actually engaging with those thoughts and taking that into our actions. And again from the pulpit, you might hear someone talk about thoughts or intrusive thoughts in ways that are not equivalent to how we're talking about them through an OCD lens,…

Kimberley Quinlan:  Mm-hmm.

Katie O'Dunne: something very different and they're really talking about more of an intentional act, in something that you're you're doing, as opposed to what we're thinking about. It's just a biological process of thoughts, moving through your mind.

ARE THOUGHTS EQUAL TO DEEDS?

Kimberley Quinlan:  Right. And and what I be right in clarifying here, is it important to differentiate between a thought you had compared to a thought that's intrusive, is that an important piece or do we not need to go to that level?

Katie O'Dunne: Do you mean, in the religious context? I, I don't know. I mean, I, I'm curious what you think from a clinical I go back to thoughts or thoughts or thoughts and…

Kimberley Quinlan: Yeah.

Katie O'Dunne: they are intrusive because we're labeling them as intrusive. Unfortunately, sometimes in religious context, and I hear this a lot, someone might go to… I hear actually from sermons all the time, where someone is saying that intrusive thoughts or in some way sinful and really what they're thinking are just regular thoughts that people are giving value to and…

Kimberley Quinlan:  Yeah. Yeah.

Katie O'Dunne: it makes it makes it really challenging for folks where they're giving more value to their thoughts and then thinking, well my preacher said that if I have a thought that's quote unquote bad that it means something about me.

EXPOSURE & RESPONSE PREVENTION (ERP) FOR RELIGIOUS OBSESSIONS/SCRUPULOSITY

Kimberley Quinlan:  I think you just hit the nail on the head,  when we apply judgment to a thought as good or bad, then we're in trouble, right. That's when things start to go sticky. Yeah. Okay, excellent. Okay. Let's talk about specific treatment for religious obsessions and exposure examples. I know for those listening we have done an episode with Jud  Steve,  I will link that in the show notes. He did go over some but I just love for you to go over like what are some examples of exposures? And how might we approach exposure and response prevention, specifically related to these religious obsessions?

Katie O'Dunne: Yeah, so his health folks, I'm not I'm not a clinician, but I work alongside a lot of really amazing clinicians in religious scrupulosity to develop exposure hierarchies. And one of the big fears when I'm working with someone is often, how could I possibly engage in exposure and response prevention because what if someone asked me to do something that's in opposition to my faith? And I want to go ahead and just put that on the table right now… I know that's a big fear and I want you to know that a good OCD specialist or an ERP therapist is really gonna work with you not to go against or to oppose your faith. But to do some things that are a little bit uncomfortable in service of you, being able to get back to your faith in a value-driven way.

Katie O'Dunne: I really believe we are never going to be incredibly excited about exposures. When I was on my own exposure and response, prevention journey, I never once walked into the office and said, Yes, I get to do this really scary exposure today. It's gonna be so fun. Well, I guess I did say that because my therapist made me pretend to be excited about exposures, but that's different. That's a different conversation was not necessarily genuine. And so i’ll often ask folks, I know that this isn't something that you want to do, but why don't you want to do it? And if the answer is well, I'm afraid that it might upset God or I'm afraid something bad might happen. That’s probably a good exposure. If the immediate response is Well, no, I'm not gonna do that. No one else in my tradition would do that. That's completely in opposition to everything we believe, probably not something that that we would ask you to do and often clinicians will use the 80/20 rule of what would 80% of the folks within your congregation be willing to do and that can be really helpful working with a faith leader as well or with other folks within your particular sect or denomination to establish that.

00:25:00

Katie O'Dunne:  The same time there. Oh my goodness, so many different exposures that we can go into. But a lot of things that I see folks commonly working on are things like praying imperfectly maybe speaking or speaking of blasphemous thought aloud or thinking through that in an intentional way, writing an aspect of that, not completing ritual washing again and again only doing it once and even thinking through the fact that it might not have been perfect that time or maybe even intentionally diverting your attention in the midst of a prayer. Sometimes for folks who are avoiding Scripture that is intentionally reading that aspect of Scripture and then maybe thinking intentionally about something that they've thought as a bad thought or that they've defined in that way. But again it very much depends for each person and I really want folks to know that it doesn't mean that you are going to be asked to eat something that goes against your dietary restrictions or to deface a religious text. Those are the two things I hear folks, very fearful of and that isn't something that you need to do in order to get better. It's about having conversation and handing over the keys to your clinician to do some uncomfortable stuff in favor of getting back to your faith in a value-driven way.

Kimberley Quinlan: Yeah, I love that. I'll tell a quick story, when I was a new intern treating OCD having no clue really what I was doing. I'm very happy to disclose that was the facts, but I had amazing supervisors and I grew up in an Episcopalian denomination and I had a client who was of similar denomination in the Christian faith. And my supervisor said, Well, okay, you're gonna have him go and say the blasphemous words and in my mind, this being my first case going like are we allowed, like side eye.And he said Okay this is your first go around. I want you to ask your client to go and speak with their religious leader and say, This is what I'm struggling with. AndI have this diagnosis and this is the treatment, it's the gold standard and Kimberley's gonna go with you and do we have permission to proceed and the minister was so wonderful. He said, If that is what's gonna bring you closer to your faith, go as hard as you can. And for me, it was just such a beautiful experience as a new clinician to have. He knew nothing about OCD but he was like if that's what you need to do to get closer, go. Like he had so much Faith himself in, I know it'll bring you to the right place and so it's so beautiful for me and that kind of helped me guide my clients to this day. Like go and get permission speak to your minister if that helps you to move forward, do you have any thoughts on that?

Katie O'Dunne: Oh yes, and this is really my favorite thing that I get to do with folks in addition to working with clinicians and clients and developing exposures, also in faith traditions that are not my own, but then I might have studied make connections to other faith leaders so we can talk about what makes the most sense in this particular set so that someone can fully live into their faith tradition while well, maybe being a little uncomfortable in this moment or doing something tough and I deeply believe whatever that looks like for you, even if the exposure seems a little bit scary, that God can handle our exposures. Across faith traditions. We see the divine as this big, wonderful powerful all knowing force and with everything going on in the world, I deeply believe theologically that the exposure that we're doing over here, which might seem really hard for us, that God can handle that as a way for us to get back to doing the things that we were actually created to do. And in that way, similar to the minister that you talked with that said, Hey, go for it. I'll even tell folks, I see ERP as a spiritual practice because a spiritual practice is defined as anything that helps you to reconnect or get closer with the divine and in that way, doing ERP really does that because it's breaking down the OCD so that you almost stop worshiping OCD and actually reconnect with God in a way that's value driven for you. That's actually what I'm getting ready to start. My doctoral research on is actually redefining ERP as a spiritual practice across faith traditions in ways that are accessible for a diverse population.

Kimberley Quinlan: And that's so beautiful, I love that. Okay, let's see. Okay, This is actually the last question, but this is actually the one I'm most excited to ask. This is actually from someone I deeply care about. They have written in and said, When I get anxious, I try to submit it to God knowing of his love and power. So, by writing a script, which is an ERP practice, for those of you who don't know, it seems I'm in conflict with my religious belief. Do you have any like points, final points, you want to make about that?

00:30:00

Katie O'Dunne: Yeah. So two big things, one going off of what I was just sharing a second ago. I would encourage you to know, or maybe not to know, for sure but, we can lean into uncertainty around this right? But to accept all of the uncertainty, while also leaning in and believing that God can handle this difficult script that you're writing or this difficult exposure that you're doing in favor of you getting to live the life that you were created to live. Not defined by OCD and that you still can pray and ask for God's support as a part of that. I would never ask someone not to continue to connect with God during some of sometimes, the most difficult process of their life which treatment can be, I know it was for me, it was incredibly scary. But rather than asking for reassurance, or asking for God, to undo any of that exposure work we're doing or or saying, oof, disregard this script I just did. We're not, we're not going to do any of those things, but rather, I would invite you to say, in whatever way makes sense to you, Dear God, please help me to lean into the uncertainty, please help me to sit with this discomfort associated with this exposure, on the way to getting back to this big, beautiful, awesome life that you've created me to live. It's really hard right now. This is really tough, but please walk with me as I sit with all of it, helping me not to push away that anxiety, but rather to be with it as I reclaim my life. Amen. Or something of that nature. Yeah.

Kimberley Quinlan:  Yeah, that's beautiful. So thank you, really. I get teary again, this is such a beautiful conversation. Okay, so number one, thank you so much for coming on, really, it's a blessing to have you here and you know, I think this will help so many folks. Is there something that we didn't cover that you you know that point that you just made alone, I feel like it's like mic drop. But is there anything else you want to add before we finish up?

Katie O'Dunne: Yeah, um, and just, and this is a little bit more Christocentric, but I think it goes across faith traditions, I often talk about the recovery Trinity and just to leave folks with this as well. That I deeply believe that it's possible to have faith in yourself, faith in the divine and faith in your treatment all at the same time and that those three pieces coming together, allowing those to be together, actually can be a huge key with religious scrupulosity, and taking a step towards your life during treatment.

Kimberley Quinlan: That's beautiful. And I've never heard that before. That is so beautiful. I'll be sure to get my staff all trained up in that as well. Thank you. oh, Katie,…

Katie O'Dunne: Oh sorry, one more thing. Sorry, as I say that and I know we're closing out. I also always want folks to know that ERP. This is, this really is my last thing. I promise.

Kimberley Quinlan:  Oh no, no. Go for it. You've got the mic go.

Katie O'Dunne:  No. Um that I've worked with a lot of folks across traditions with religious scroup and I would say um a majority of the folks that I've worked with have moved through ERP and at the other side actually have a deeper relationship with their faith then maybe they did before and I would encourage you to hear that that actually leaning into that uncertainty translates far beyond OCD sometimes into a closer relationship with God. And I've worked with folks who have moved through ERP that end up going into ministry because that's meaningful to them in a way that isn't driven by OCD. So just knowing that it doesn't ever mean, you're stepping away from your faith, you're taking actually this leap of faith to reconnect with it in a way that's actually authentic to you.

Kimberley Quinlan: Mmhm. I'm so grateful that you added that. Isn't that some of the truth, with OCD in general, like the more you want certainty, the less of it you have. And the more you let go of it, the more you can kind of have that value driven life. I love it. Okay, I can't thank you enough, really, this has been such a beautiful conversation. I probably nearly cried like four times and I don't, I don't often get to that. It's just so, so beautiful and deep. And I think it's, it's wonderful. Thank you. Where will people hear about, you get to know you reach out to you and so forth.

Katie O'Dunne: Yeah, so folks are more than welcome to reach out to me via Instagram at @RevkRunsBeyondOCD or on my website at RevKatieO'dunne.com. I do lots of work again with clinicians and faith, leaders and clients but also have free weekly faith and OCD support groups along with interfaith prayer services for folks navigating what it means to lean into their faith traditions from a space of uncertainty and an inclusive environment. And then I would also encourage folks to check out our upcoming Faith and OCD conference with the Iocdf in May along with a really awesome resource page that we were so proud to put out last year. I had the chance to work with a really great team of clinicians and faith leaders to create a resource page for all of you to see what scrupulosity might look like in your faith tradition along with resources. So check out all of those wonderful things.

00:35:00

Kimberley Quinlan: Amazing. We will have all that linked in the show notes. Thank you, Katie, really! It's such an honor to have you on the show.Katie O'Dunne: Thank you. This was lovely. Thank you so much.

Feb 10, 2023

5 TIPS FOR HEALTH ANXIETY DURING A DRS VISIT

If you want my five tips for health anxiety during a Drs visit, especially if you have a medical condition that concerns you, this is the episode for you.



Hello and welcome back everybody. Today, I’m going to share some updates about a recent medical issue I have had, and I’m going to share specific tips for dealing with health anxiety (also known as hypochondria). 

323 5 tips for health anxiety

A lot of you who have been here with me before know I have postural orthostatic tachycardic syndrome. I also have a lesion on my left cerebellum and many other ups and downs in my medical history where I’ve had to get really good at managing my health anxiety. I wanted to share with you some real-time tips that I am practicing as I deal with another medical illness or another medical concern that I wanted to share with you. 

Here I’m going to share with you five specific tips, but I think in total, there’s 20-something tips all woven in here. I’ve done my best to put them into just five. But do make sure you listen to the end of the podcast episode because I’m also going to give some health anxiety journal prompts or questions that you can ask yourself so that you can know how to deal with health anxiety if you’re experiencing that at this time. 

Before we get into it, let me give you a little bit of a backstory. Several months ago, I did share that I’ve been having these what I call surges. They’re like adrenaline surges. They wake me up. My heart isn’t racing. It’s not like it’s racing fast, but the only way I can explain it is I feel like I have like a racehorse’s heart in my chest, like this huge heart that’s beating really heavily. Of course, that creates anxiety. And so then I would question like, is it the heartbeat or is it just my anxiety? You go back and you go forward trying to figure out which is which. But because this was a symptom that was persisting and was also showing up when I wasn’t experiencing a lot of stress or anxiety, I thought the right thing to do is to go and see the doctor. 

WHAT HEALTH ANXIETY FEELS LIKE

Before we get started, be sure to make sure you’re not avoiding doctors. Make sure you’re not dismissing symptoms. We do have to find a very, very wise balance between avoiding doctors but also not overdoing it with doctors. We’ll talk about that a little bit here in a minute. But first, I wanted to just share with you what health anxiety feels like for me. Because for me, I’m very, very skilled at identifying what is anxiety and what is not. I’ve become very good at catching that by experience, folks. It’s not something that comes naturally, but by experience, I can identify what is health anxiety and what is a real medical condition or what is something worthy of me getting checked out. 

For me, for the health anxiety piece, it’s really this sort of anxiety that is a sense of catastrophization and it’s usually in the form of thoughts like, what if this is cancer? What if this is a stroke? All the worst-case scenarios. What if this is life-threatening? What if I miss this and you are responsible, you should have picked it up. These are very common health anxiety intrusive thoughts or health anxiety thoughts that I think you really need to be able to catch and be aware and mindful of. First of all, that is the biggest symptom for me. 

The other thing is when you have health anxiety, you do tend to hyper-fixate on the symptom and all of the surrounding symptoms that are going with that. And then you can really catastrophize those like, “Well, my heart’s beating really heavily and I feel dizzy. Oh my gosh. And I’ve been having a headache. Yeah, you’re right, I’ve been having a headache. Oh my gosh.” I call it ‘gathering.’ That’s not an actual clinical term, but I do use it with my clients. We gather data that is catastrophic to make it seem like, yeah, we actually have a really big point, and this is actually a catastrophe. 

Some other health anxiety symptom that I experience is panic. When you notice a symptom, it is very common to start panicking. And then again, you go back to this chicken or the egg or is it the horse or the carriage in terms of I’m panicking, and now the panic has all these symptoms. Are these symptoms an actual medical condition or are they actually just anxiety and panic? You could spend a lot of time stuck in that cycle trying to figure that out. 

Let’s now talk about how to manage these symptoms and some tips and tools that you can use. 

Tip #1: No Googling

Let me tell you what has recently happened to me. I’ve been having these symptoms. I made an appointment to see my cardiologist. It was two months out and I was like, “It’s not a big deal. I can handle these symptoms.” I’m feeling super confident about my ability now to just ride out some pretty uncomfortable sensations and not catastrophize. I go in for my checkup, they do an echocardiogram, and it’s taking a long time. She’s asking me these strange questions like, “Why are you here again,” as she’s doing it. She’s checking, she’s looking, she’s squinting at the screen. “Why are you here again? What are your symptoms?” Click, click, click, looking at the heart, whatever. Again, I’m in my mind going, “Kimberley, let your brain have whatever thoughts it wants. We’re not going to catastrophize.” I was doing really, really well. I got up and I answered her questions. I did the whole appointment. She cleaned me off when I was done and said, “Great, you’ve got 24 hours and then the doctor will email you with your results.”

And then yesterday afternoon, I get a call from the nurse saying, “We need to book you a video appointment with the doctor to discuss your results.” As you can imagine, my brain went berserk. My health anxiety thoughts were saying, “This is really bad. Why would he need to make a video appointment? This can only end badly. This must be cancer. This must be heart problems. Am I going to have a heart attack and so forth?” Of course, my brain did that. I’m grateful my brain does that because that’s my brain being highly functioning and aware. 

But the number one rule I made with myself in that exact moment, even though that was very anxiety-producing, is no Googling. Kimberley, you are not allowed to pick up the computer or the iPhone and Google anything about this.

That is tip #1 for you. I’ll tell you why. A lot of my patients say, “But why? It’s no harm. I’m not doing any harm.” And I’ll say, “Yes.” I’ve actually just seen my cardiologist. But now that I’ve had my appointment, he encouraged me to do a little research. What was hilarious to me is every single website is different and some catastrophize and some don’t. Some go, “This could be very normal.” Other ones say, “This could be cancer, cancer, cancer, cancer.”

This is why I’m telling my patients all the time, don’t Google because what you read is different. It’s not like this is going to be a factual thing. Most of the time people who have articles that rank high on Google searches are the ones who have optimized their website to be very easy to Google. The reason they have become number one on the Google algorithm is because they’ve included keywords like cancer for blah, blah, blah, and all of these health issues and health names. The ones that are at the top, some of them are very reasonable, helpful, and accurate, but a lot of them are not. They’ve just really done a great job of putting in lots and lots of keywords that makes them highly searchable and come up high on the algorithm.

Please, number one, do not Google. Go to your doctor for questions if you have any. Unless they’ve encouraged you to do research, do not Google.

TIP #2: FOLLOW IMPORTANT HEALTH ANXIETY CBT TECHNIQUES

I’ve actually categorized this in a bigger category and I’ve called it important health anxiety CBT techniques, because there are some important CBT tools that you’re going to need here and here we go. 

While I was in getting my echocardiogram, I was laying and I was having some anxiety because she was squinting and asking some strange questions, not in the normal of what I’d experienced. I could feel the pull to check her face for reassurance like, does she look concerned? Does she look relaxed? What’s going on with her? I wonder what she meant. 

What I want to encourage you to do is acknowledge and catch when you’re checking their face to try to decipher what the nurse or the assistant or the doctor is doing and saying. Because really, all I’m doing there is mind reading because I have no idea what she’s thinking. I was laughing at myself because she was squinting and looking concerned. I was like, “I wonder if she’s trying not to pass gas.” We could mind read that she thinks I have cancer and that there’s a big problem, or maybe she’s just trying not to pass gas right now. Maybe she’s thinking about a fight she just had with her partner. My attempt to analyze her facial expression is a complete waste of my time. You could use that tip anytime you want. 

The next tip for you is no reassurance seeking with nurses or doctors. Now, I actually felt almost into this trap. If I’m being completely honest, I did fall into this trap, but I caught myself really quickly. As she was finishing up, she took off her gloves and got ready to discharge me, and I said, “So, you’d let me know if there was...” I paused because what I was going to say is, “You’ll let me know if there’s something wrong, right?” I was going to say that. And then I was like, “No, no, no.” I stopped myself and said, “You know what? I know the deal. I’ve done these enough times. I know I have to wait for the doctor.” But I caught myself wanting to get confirmation from the nurse and I already know that nurses are not allowed to give me any diagnosis anyway. I caught myself wanting to get some expression of relief from her like, “No, you’re fine. Everything looks good,” or whatever. Sometimes they accidentally give you that reassurance. But I caught myself seeking reassurance from her. 

In addition to that—let me talk to you a little later about how we do that with doctors as well—often if you’re in the office with a doctor, you may find yourself at the end of the session going, “I’ll be fine, right? It’s not bad, right?” It’s okay, we’re all going to ask some of those questions. I’m not going to be the reassurance-seeking police with you. But what I want you to do is really drop down into catching when we’re engaging in reassurance seeking and using it too much to reduce our own anxiety about it, to take away our own anxiety or fear.

Now, another CBT technique or sort of rule that we often set in clinical work when I’m talking with my clients who have health anxiety is also not swaying the doctor or the nurse to answer things in the way that you want. A lot of people fall into this trap. For me, I just had my doctor’s appointment. We are working through and there are some little problems that we will work out. But I caught myself there wanting to sway him to be very positive. We had talked about it ultimately. He had said, “There are some issues. It could be this, it could be that, it could be this.” He listed off three or four options. Some were very, very small, and of course, the third one is always like, it could be cancer. They always say at the end, like whatever.

When they give you these three or four or five options on what the problem might be, it’s very important that you be mindful and aware of how you’re trying to sway the doctor to give you certainty. This is what my doctor said, and I’m going to be brief. I’m not going to bore you with my medical stuff, but he’ll say, “It could be that you recently had COVID or an illness or a virus. It could also be this other condition, which is common, and if it’s so, we’ll treat that. It could also be that there could be some rheumatoid arthritis and that’s a longer treatment. And then the final thing, which we don’t think so, but it also could be cancer. “Let’s say he lists off these four options. 

Now, this is very common. Doctors will do this often because their job is to educate us on all of the possibilities so that we can create a treatment plan that doesn’t ignore big issues, but we have to be careful that we don’t spend their time and our time going, “You think it’s the first one, right? It’s probably just the first one. I probably just had a virus, right?” I’m really swaying him towards giving an answer when he’s already told us that he or she doesn’t know yet. He’s already said, “I don’t know yet. We’re going to need to do extra tests.”

Catch yourself trying to get them to reassure you and confirm that it’s definitely not the C word. The cancer word is what I’m saying there. Catch yourself when you’re doing those behaviors in the office with either the nurses or the technician or the doctors. Very, very important. 

Now, one other thing I want you to also catch is if you’re coming to them with something, let’s say you are coming to them with a concern that you’ve pretty much know is your health anxiety, but you want reassurance that it’s not, also be careful that you don’t overly list things to convince them that something is wrong. A lot of you don’t do this, I know, but I have had a lot of clients who’ve come back to me after seeing the doctor and said, “Do you have any other symptoms,” and they would list even minor symptoms that they had a month ago that they knew had nothing to do with it. But they felt like if they didn’t say it all, if they didn’t include every symptom, every stomach ache, every headache, everything, they could miss something. So also keep an eye out for that.

That’s some sort of overall general CBT techniques we use for health anxiety that help guide people into not engaging in those health anxiety compulsions.

TIP #3: HEALTH ANXIETY HELP DURING YOUR DOCTOR’S VISIT

This is a really important part of it. From the minute that I got the call from the nurse that he wanted a video call with me, my mind went to, again, the worst-case scenario. It just does. It just does. I think that that is actually really, really normal. I really do. I think that is what happens naturally for anybody. First of all, I don’t want to even go too over in terms of pathologizing that. I think that’s a normal thing for anybody to experience. 

The first thing I want you to practice is validating your anxiety. It’s a part of self-compassion practice. It’s going, “It makes complete sense, Kimberley, that this is concerning you.” That’s one of the most important self-compassionate statements you could make for yourself. “It makes complete sense that this is hard, this is scary. Of course, it’s making you uncomfortable.” It’s validating. 

You might even move to a common humanity, going, “Anybody in this situation would have anxiety.” Then you can also move into mindfulness skills, which is—this was one that I hold very true—just because I feel anxious doesn’t mean there’s danger or there’s a catastrophe. It’s my body’s natural response to create anxiety when it feels threatened. That keeps me alive. That’s a good thing. But just because I’m anxious and having thoughts about scary things doesn’t mean they’re facts. Remember, thoughts are not facts.

The next thing here is also being able to just observe them, again, while you’re sitting in the waiting room. They were playing the movie, what’s it called? Moana. And I love Moana. I remember watching it as a child. I’m sitting in the seat and my mind is offering me all of these health anxiety intrusive thoughts, and my mind really wants me to pay attention to them. 

A part of my mindfulness practice was to go, “I am noticing I’m having these catastrophic thoughts, but I’m also noticing Moana, and I’m going to choose which one I give my attention to.” I’m not going to push them away. I’m not going to make the thoughts go away because they’re naturally going to be there. I basically knew from yesterday afternoon until 9:00 AM this morning that the thoughts were going to be there and I accepted them there. I didn’t go in saying, “Oh gosh, I hope the next 24 hours aren’t filled with thoughts.” I was like, they’re going to be, “Hello thoughts, welcome. I know you’re going to be here,” and I’m going to train my brain to put attention on what matters to me. In this case, I’m not going to make these thoughts important. I’m going to watch Moana. I’m going to look at the colors, I’m going to listen to the sounds, I’m going to notice whatever it is that I notice. I’m going to notice the fabric of the seat underneath me as I’m waiting in the room. Last night as I went to bed, I’m just going to notice the feeling of the cushions underneath me. This is mindfulness and this is so important—being present and paying attention to what is currently happening instead of the worst-case scenario.

There’s one important point here, which is my mind kept saying, “By nine o’clock tomorrow, your life might change.” You guys know what? If you’re listening, I’m guessing you know what that’s like. You’re like, “After this appointment, this appointment may change your life for the worse.” My job was to go, “Maybe, maybe not. It could be that he just wants to tell me everything’s okay.”

It is what it is. It will be what it will be. I will work through it and solve it when it happens. I’m not going to live the next 24 hours or the next 12 hours coming from a place of the worst-case scenario until I have actual evidence of that. So we are not going to live your life as you wait for your appointment. We’re not going to live your life through the lens of the worst case. We’re going to live through it through being uncertain and accepting that in this moment, nothing is wrong. Until we know, we don’t know. 

MEDITATION FOR HEALTH ANXIETY

Now, other options for you, I’m just going to add a couple here, is I have found meditation for health anxiety to be very, very helpful, particularly when health anxiety is taking over. That has been very beneficial for me—to find a meditation that can actually sometimes give me some concrete skills to use in the moment to stay present. We are not going towards staying calm because maybe you’re going to have some anxiety. That’s okay. Really what we want to do is we want to be working in the most skillful fashion as we can. 

And then the last one, this one’s a little controversial. Some people don’t agree with this piece of advice, so take what you need and leave what doesn’t help. But for me, when I’m anxious, I tend to shallow breathe a lot. I hold my breath a lot. For me, it was just reminding myself just to breathe. Not breathe in any particular fashion or deep breathing, but just be like, “Take a breath, Kimberley, when you need. Take a breath when you need.”

TIP #4: WHAT TO DO WHEN HEALTH ANXIETY TAKES OVER?

Tip #4 is what to do when anxiety takes over in the biggest way, and that ultimately means, what can you do when your brain is setting on the full alarm. Now in this case, I’m just going to say it’s basically what to do if you’re panicking and the advice goes the same as it is whether there’s a health anxiety panic attack or a regular non-health anxiety panic attack, which is do not try to push the anxiety away. Let’s break it down.

If you’re having anxiety, and you are saying, “This is bad, I don’t want it, it shouldn’t be here,” you’re actually telling your brain that the anxiety is dangerous. Not just the health issue, but also the presence of anxiety is dangerous, which means it’s going to pump out more and more anxiety because you’ve told it that anxiety is dangerous. Your job here is to let the anxiety be there. Try not to push it away. What we know is what you try to push away comes stronger. 

You can talk to your anxiety. There’s actually research to show that when you talk to your anxiety and you talk to yourself in the third person, it can actually empower you and feel more of a sense of empowerment and mastery over that experience. For me, unfortunately, I’ve had quite the 24 hours. We actually had a very large earthquake last night here in southern California, which woke me up, so I had some anxiety related to that. And then of course, my brain was like, “Oh yeah, and by the way, you might have cancer. Ha-ha-ha!” You know what I mean? Of course, your brain’s going to tell you that. 

In that moment, I used the skill and the research around talking to myself in the third person. I said, “Kimberley, there’s nothing you can do right now. It makes total sense that you have anxiety. Let’s not push it away. Let’s bring your attention to what you can control, which is how kind you are to yourself, whether you’re clenching your body up, whether you’re breathing, whether what you’re putting your attention on. You can’t control anything. You can’t control this earthquake. You can’t control what’s happening tomorrow. All you can do is be here now.” Using a third person, using your name as the third person like, “Kimberley...” and saying what you need to do. Coaching yourself has been incredibly helpful for me and I know for a lot of people because that’s actually science-based. 

TIP #5: ENGAGE IN VALUE-BASED BEHAVIORS

The next thing I want you to do, and this is the final one before we go through some questions that I want you to ask yourself, is to engage in value-based behaviors. Now what that means is when we’re anxious, when we have health anxiety, it’s very normal for us to want to engage in safety behaviors. One for me was every morning, I drop my daughter off and my husband drops my son off at school and I could feel my anxiety wanting to stay home. I don’t want to go out. And so I almost was starting to say, “Maybe I’ll ask my husband to drop off my daughter and my son so I can stay home.” I recognize that would be me doing a fear-based behavior. I would be doing that only because I don’t want to face fear today. I just want to make it small. 

Number one, it’s okay. If you need to do that, that’s totally okay. But for me personally, I caught myself and I said, “No, you value being someone who drops off your daughter and shows up and doesn’t let anxiety win. You love dropping off your daughter. If you stayed home, you’d only be doing the dishes, circling around, maybe catastrophizing, just trying to get past time. You love taking your daughter to drop off.” And so engage in that. 

Another value-based behavior for me personally is humor. I’m texting friends and I’m telling them jokes about what I’m going to do to my doctor if he says something wrong or something, or I’m making jokes about some of the questions and statements that the nurses made. I’m making jokes about it, not to catastrophize, not to put them down, not to minimize my own discomfort, but humor is a very big part of my values. I’m making jokes about what we’ll do if it’s cancer and will you come to my funeral and silly things. Again, I really want to make sure you understand, I’m not doing that as depressed bad things are going to happen. I’m doing it because I’m literally saying, it will be what it will be. Let’s just move forward and let’s actually bring some light and joy and some laughter to this. 

Now you might not like that. If that’s not your values, don’t do it, but identify, what would the non-anxious me do right now? What would I do if this fear wasn’t here? And then do those behaviors. It’s really, really important that you make sure you hit this in as many ways as you can because fear can cause us just to clam up and sit still and ruminate. It’s very important that you practice not just ruminating and cycling and going over and over and over and over all of the worst-case scenarios because your brain will take you to some very dark places.

HEALTH ANXIETY JOURNAL PROMPTS

This is really important. I know I’ve given you the top five, but that’s more like 20 points. Let’s talk about some hypochondria or health anxiety journal prompts or questions you can ask yourself to stay as skilled as you can. 

  • What is in my control right now? 

What is in my control? My behaviors, my reactions. That’s ultimately what is in your control. What’s not in your control is how much anxiety you have and what thoughts you have about them. 

  • What is not in my control? 

You can be very specific here. In my case, it’s like, what’s not in my control is what the doctor says. What’s not in my control is what my health condition is. What’s not in my control is when he calls. You know what I mean? What’s not in my control is the treatment plan. I’m going to have to wait for him to do that. I’m identifying what is in my control and what is not. 

  • How am I going to gain a sense of control that is helpful to both my long-term health anxiety recovery goals and my health anxiety treatment plan? 

For me, I know that Googling is going to be a full sense of control and doesn’t help my long-term recovery, so I’m not going to do it. I know that me ruminating and doing tons of mental compulsions is going to give me a sense of control, but it’s not helpful. It’s not helpful. It doesn’t help my long-term recovery, it doesn’t help my long-term mental health, so I’m not going to do it. 

What will help my long-time health anxiety goals, it’s going to be all the tips that we covered today—no Googling, no checking faces, no reassurance seeking, no swaying the doctor, practicing my mindfulness, being as compassionate as I can, maybe taking some breaths. All of those are going to make me stronger in my health anxiety recovery instead of weaker the ones which would be ruminating and doing all of these. Not very helpful safety behaviors. 

  • How willing am I to be uncertain right now? 

You guys are going to have to tolerate a lot of uncertainty. That’s what this is all about. From the minute I got the call from that nurse saying that I needed to have this video appointment, from the minute he got onto the video appointment, all I had to focus on is, am I willing to be uncomfortable? Am I willing to be uncertain? Because the only reason I would’ve Googled was because I wanted certainty. Really, really important. 

  • What would the non-anxious me do right now? 

She’d get up and she’d go and drop her daughter off, and then she’d call your friend because that’s what you do every Wednesday morning. She’d respond to emails, she’d call. Do whatever it is that you’re doing. What would the non-anxious you do?

  • How can I be kind and gentle towards myself as I navigate this experience? 

Another code question for that is, what do I need right now that is skillful? What do you need? The most beautiful thing about this is my husband. He is the most gorgeous man. He sits down. He doesn’t reassure me, he just says, “I got you.” If your partner is giving you a lot of reassurance, you might want to mention to them, “That actually doesn’t help my long-term health anxiety. I just need you to be next to me and support me.” And so it’s very important that we make sure our partners aren’t giving us a whole bunch of reassurance and a whole bunch of certainty-seeking behaviors that keep us stuck. 

That’s it guys. There are my five tips for health anxiety which turned out to be more like 20, I know, but I try to always overdeliver. I really wanted to jam in as many skills as I could.

I hope you have a wonderful day. Please do not worry about me. I am actually fine. There’s a joke between my best friend and I. We say, “Are you fine number one or fine number two?” Fine number one is you actually are fine and fine number two is you’re not fine, but you’re saying you are, and I am fine number one. I actually have a lot of faith in my doctors. I have a lot of faith in my ability to handle these things and these are just another bump on the road in terms of being someone who has postural orthostatic tachycardic syndrome. So all is well. All is well. I am fine number one and I hope you are fine number one as well. 

I am sending you so much love. Do not forget, it is a beautiful day to do all the hard things, and I’ll see you next week.

Feb 10, 2023

5 TIPS FOR HEALTH ANXIETY DURING A DRS VISIT

If you want my five tips for health anxiety during a Drs visit, especially if you have a medical condition that concerns you, this is the episode for you.



Hello and welcome back everybody. Today, I’m going to share some updates about a recent medical issue I have had, and I’m going to share specific tips for dealing with health anxiety (also known as hypochondria). 

A lot of you who have been here with me before know I have postural orthostatic tachycardic syndrome. I also have a lesion on my left cerebellum and many other ups and downs in my medical history where I’ve had to get really good at managing my health anxiety. I wanted to share with you some real-time tips that I am practicing as I deal with another medical illness or another medical concern that I wanted to share with you. 

Here I’m going to share with you five specific tips, but I think in total, there’s 20-something tips all woven in here. I’ve done my best to put them into just five. But do make sure you listen to the end of the podcast episode because I’m also going to give some health anxiety journal prompts or questions that you can ask yourself so that you can know how to deal with health anxiety if you’re experiencing that at this time. 

Before we get into it, let me give you a little bit of a backstory. Several months ago, I did share that I’ve been having these what I call surges. They’re like adrenaline surges. They wake me up. My heart isn’t racing. It’s not like it’s racing fast, but the only way I can explain it is I feel like I have like a racehorse’s heart in my chest, like this huge heart that’s beating really heavily. Of course, that creates anxiety. And so then I would question like, is it the heartbeat or is it just my anxiety? You go back and you go forward trying to figure out which is which. But because this was a symptom that was persisting and was also showing up when I wasn’t experiencing a lot of stress or anxiety, I thought the right thing to do is to go and see the doctor. 

WHAT HEALTH ANXIETY FEELS LIKE

Before we get started, be sure to make sure you’re not avoiding doctors. Make sure you’re not dismissing symptoms. We do have to find a very, very wise balance between avoiding doctors but also not overdoing it with doctors. We’ll talk about that a little bit here in a minute. But first, I wanted to just share with you what health anxiety feels like for me. Because for me, I’m very, very skilled at identifying what is anxiety and what is not. I’ve become very good at catching that by experience, folks. It’s not something that comes naturally, but by experience, I can identify what is health anxiety and what is a real medical condition or what is something worthy of me getting checked out. 

For me, for the health anxiety piece, it’s really this sort of anxiety that is a sense of catastrophization and it’s usually in the form of thoughts like, what if this is cancer? What if this is a stroke? All the worst-case scenarios. What if this is life-threatening? What if I miss this and you are responsible, you should have picked it up. These are very common health anxiety intrusive thoughts or health anxiety thoughts that I think you really need to be able to catch and be aware and mindful of. First of all, that is the biggest symptom for me. 

The other thing is when you have health anxiety, you do tend to hyper-fixate on the symptom and all of the surrounding symptoms that are going with that. And then you can really catastrophize those like, “Well, my heart’s beating really heavily and I feel dizzy. Oh my gosh. And I’ve been having a headache. Yeah, you’re right, I’ve been having a headache. Oh my gosh.” I call it ‘gathering.’ That’s not an actual clinical term, but I do use it with my clients. We gather data that is catastrophic to make it seem like, yeah, we actually have a really big point, and this is actually a catastrophe. 

Some other health anxiety symptom that I experience is panic. When you notice a symptom, it is very common to start panicking. And then again, you go back to this chicken or the egg or is it the horse or the carriage in terms of I’m panicking, and now the panic has all these symptoms. Are these symptoms an actual medical condition or are they actually just anxiety and panic? You could spend a lot of time stuck in that cycle trying to figure that out. 

Let’s now talk about how to manage these symptoms and some tips and tools that you can use. 

Tip #1: No Googling

Let me tell you what has recently happened to me. I’ve been having these symptoms. I made an appointment to see my cardiologist. It was two months out and I was like, “It’s not a big deal. I can handle these symptoms.” I’m feeling super confident about my ability now to just ride out some pretty uncomfortable sensations and not catastrophize. I go in for my checkup, they do an echocardiogram, and it’s taking a long time. She’s asking me these strange questions like, “Why are you here again,” as she’s doing it. She’s checking, she’s looking, she’s squinting at the screen. “Why are you here again? What are your symptoms?” Click, click, click, looking at the heart, whatever. Again, I’m in my mind going, “Kimberley, let your brain have whatever thoughts it wants. We’re not going to catastrophize.” I was doing really, really well. I got up and I answered her questions. I did the whole appointment. She cleaned me off when I was done and said, “Great, you’ve got 24 hours and then the doctor will email you with your results.”

And then yesterday afternoon, I get a call from the nurse saying, “We need to book you a video appointment with the doctor to discuss your results.” As you can imagine, my brain went berserk. My health anxiety thoughts were saying, “This is really bad. Why would he need to make a video appointment? This can only end badly. This must be cancer. This must be heart problems. Am I going to have a heart attack and so forth?” Of course, my brain did that. I’m grateful my brain does that because that’s my brain being highly functioning and aware. 

But the number one rule I made with myself in that exact moment, even though that was very anxiety-producing, is no Googling. Kimberley, you are not allowed to pick up the computer or the iPhone and Google anything about this.

That is tip #1 for you. I’ll tell you why. A lot of my patients say, “But why? It’s no harm. I’m not doing any harm.” And I’ll say, “Yes.” I’ve actually just seen my cardiologist. But now that I’ve had my appointment, he encouraged me to do a little research. What was hilarious to me is every single website is different and some catastrophize and some don’t. Some go, “This could be very normal.” Other ones say, “This could be cancer, cancer, cancer, cancer.”

This is why I’m telling my patients all the time, don’t Google because what you read is different. It’s not like this is going to be a factual thing. Most of the time people who have articles that rank high on Google searches are the ones who have optimized their website to be very easy to Google. The reason they have become number one on the Google algorithm is because they’ve included keywords like cancer for blah, blah, blah, and all of these health issues and health names. The ones that are at the top, some of them are very reasonable, helpful, and accurate, but a lot of them are not. They’ve just really done a great job of putting in lots and lots of keywords that makes them highly searchable and come up high on the algorithm.

Please, number one, do not Google. Go to your doctor for questions if you have any. Unless they’ve encouraged you to do research, do not Google.

TIP #2: FOLLOW IMPORTANT HEALTH ANXIETY CBT TECHNIQUES

I’ve actually categorized this in a bigger category and I’ve called it important health anxiety CBT techniques, because there are some important CBT tools that you’re going to need here and here we go. 

While I was in getting my echocardiogram, I was laying and I was having some anxiety because she was squinting and asking some strange questions, not in the normal of what I’d experienced. I could feel the pull to check her face for reassurance like, does she look concerned? Does she look relaxed? What’s going on with her? I wonder what she meant. 

What I want to encourage you to do is acknowledge and catch when you’re checking their face to try to decipher what the nurse or the assistant or the doctor is doing and saying. Because really, all I’m doing there is mind reading because I have no idea what she’s thinking. I was laughing at myself because she was squinting and looking concerned. I was like, “I wonder if she’s trying not to pass gas.” We could mind read that she thinks I have cancer and that there’s a big problem, or maybe she’s just trying not to pass gas right now. Maybe she’s thinking about a fight she just had with her partner. My attempt to analyze her facial expression is a complete waste of my time. You could use that tip anytime you want. 

The next tip for you is no reassurance seeking with nurses or doctors. Now, I actually felt almost into this trap. If I’m being completely honest, I did fall into this trap, but I caught myself really quickly. As she was finishing up, she took off her gloves and got ready to discharge me, and I said, “So, you’d let me know if there was...” I paused because what I was going to say is, “You’ll let me know if there’s something wrong, right?” I was going to say that. And then I was like, “No, no, no.” I stopped myself and said, “You know what? I know the deal. I’ve done these enough times. I know I have to wait for the doctor.” But I caught myself wanting to get confirmation from the nurse and I already know that nurses are not allowed to give me any diagnosis anyway. I caught myself wanting to get some expression of relief from her like, “No, you’re fine. Everything looks good,” or whatever. Sometimes they accidentally give you that reassurance. But I caught myself seeking reassurance from her. 

In addition to that—let me talk to you a little later about how we do that with doctors as well—often if you’re in the office with a doctor, you may find yourself at the end of the session going, “I’ll be fine, right? It’s not bad, right?” It’s okay, we’re all going to ask some of those questions. I’m not going to be the reassurance-seeking police with you. But what I want you to do is really drop down into catching when we’re engaging in reassurance seeking and using it too much to reduce our own anxiety about it, to take away our own anxiety or fear.

Now, another CBT technique or sort of rule that we often set in clinical work when I’m talking with my clients who have health anxiety is also not swaying the doctor or the nurse to answer things in the way that you want. A lot of people fall into this trap. For me, I just had my doctor’s appointment. We are working through and there are some little problems that we will work out. But I caught myself there wanting to sway him to be very positive. We had talked about it ultimately. He had said, “There are some issues. It could be this, it could be that, it could be this.” He listed off three or four options. Some were very, very small, and of course, the third one is always like, it could be cancer. They always say at the end, like whatever.

When they give you these three or four or five options on what the problem might be, it’s very important that you be mindful and aware of how you’re trying to sway the doctor to give you certainty. This is what my doctor said, and I’m going to be brief. I’m not going to bore you with my medical stuff, but he’ll say, “It could be that you recently had COVID or an illness or a virus. It could also be this other condition, which is common, and if it’s so, we’ll treat that. It could also be that there could be some rheumatoid arthritis and that’s a longer treatment. And then the final thing, which we don’t think so, but it also could be cancer. “Let’s say he lists off these four options. 

Now, this is very common. Doctors will do this often because their job is to educate us on all of the possibilities so that we can create a treatment plan that doesn’t ignore big issues, but we have to be careful that we don’t spend their time and our time going, “You think it’s the first one, right? It’s probably just the first one. I probably just had a virus, right?” I’m really swaying him towards giving an answer when he’s already told us that he or she doesn’t know yet. He’s already said, “I don’t know yet. We’re going to need to do extra tests.”

Catch yourself trying to get them to reassure you and confirm that it’s definitely not the C word. The cancer word is what I’m saying there. Catch yourself when you’re doing those behaviors in the office with either the nurses or the technician or the doctors. Very, very important. 

Now, one other thing I want you to also catch is if you’re coming to them with something, let’s say you are coming to them with a concern that you’ve pretty much know is your health anxiety, but you want reassurance that it’s not, also be careful that you don’t overly list things to convince them that something is wrong. A lot of you don’t do this, I know, but I have had a lot of clients who’ve come back to me after seeing the doctor and said, “Do you have any other symptoms,” and they would list even minor symptoms that they had a month ago that they knew had nothing to do with it. But they felt like if they didn’t say it all, if they didn’t include every symptom, every stomach ache, every headache, everything, they could miss something. So also keep an eye out for that.

That’s some sort of overall general CBT techniques we use for health anxiety that help guide people into not engaging in those health anxiety compulsions.

TIP #3: HEALTH ANXIETY HELP DURING YOUR DOCTOR’S VISIT

This is a really important part of it. From the minute that I got the call from the nurse that he wanted a video call with me, my mind went to, again, the worst-case scenario. It just does. It just does. I think that that is actually really, really normal. I really do. I think that is what happens naturally for anybody. First of all, I don’t want to even go too over in terms of pathologizing that. I think that’s a normal thing for anybody to experience. 

The first thing I want you to practice is validating your anxiety. It’s a part of self-compassion practice. It’s going, “It makes complete sense, Kimberley, that this is concerning you.” That’s one of the most important self-compassionate statements you could make for yourself. “It makes complete sense that this is hard, this is scary. Of course, it’s making you uncomfortable.” It’s validating. 

You might even move to a common humanity, going, “Anybody in this situation would have anxiety.” Then you can also move into mindfulness skills, which is—this was one that I hold very true—just because I feel anxious doesn’t mean there’s danger or there’s a catastrophe. It’s my body’s natural response to create anxiety when it feels threatened. That keeps me alive. That’s a good thing. But just because I’m anxious and having thoughts about scary things doesn’t mean they’re facts. Remember, thoughts are not facts.

The next thing here is also being able to just observe them, again, while you’re sitting in the waiting room. They were playing the movie, what’s it called? Moana. And I love Moana. I remember watching it as a child. I’m sitting in the seat and my mind is offering me all of these health anxiety intrusive thoughts, and my mind really wants me to pay attention to them. 

A part of my mindfulness practice was to go, “I am noticing I’m having these catastrophic thoughts, but I’m also noticing Moana, and I’m going to choose which one I give my attention to.” I’m not going to push them away. I’m not going to make the thoughts go away because they’re naturally going to be there. I basically knew from yesterday afternoon until 9:00 AM this morning that the thoughts were going to be there and I accepted them there. I didn’t go in saying, “Oh gosh, I hope the next 24 hours aren’t filled with thoughts.” I was like, they’re going to be, “Hello thoughts, welcome. I know you’re going to be here,” and I’m going to train my brain to put attention on what matters to me. In this case, I’m not going to make these thoughts important. I’m going to watch Moana. I’m going to look at the colors, I’m going to listen to the sounds, I’m going to notice whatever it is that I notice. I’m going to notice the fabric of the seat underneath me as I’m waiting in the room. Last night as I went to bed, I’m just going to notice the feeling of the cushions underneath me. This is mindfulness and this is so important—being present and paying attention to what is currently happening instead of the worst-case scenario.

There’s one important point here, which is my mind kept saying, “By nine o’clock tomorrow, your life might change.” You guys know what? If you’re listening, I’m guessing you know what that’s like. You’re like, “After this appointment, this appointment may change your life for the worse.” My job was to go, “Maybe, maybe not. It could be that he just wants to tell me everything’s okay.”

It is what it is. It will be what it will be. I will work through it and solve it when it happens. I’m not going to live the next 24 hours or the next 12 hours coming from a place of the worst-case scenario until I have actual evidence of that. So we are not going to live your life as you wait for your appointment. We’re not going to live your life through the lens of the worst case. We’re going to live through it through being uncertain and accepting that in this moment, nothing is wrong. Until we know, we don’t know. 

MEDITATION FOR HEALTH ANXIETY

Now, other options for you, I’m just going to add a couple here, is I have found meditation for health anxiety to be very, very helpful, particularly when health anxiety is taking over. That has been very beneficial for me—to find a meditation that can actually sometimes give me some concrete skills to use in the moment to stay present. We are not going towards staying calm because maybe you’re going to have some anxiety. That’s okay. Really what we want to do is we want to be working in the most skillful fashion as we can. 

And then the last one, this one’s a little controversial. Some people don’t agree with this piece of advice, so take what you need and leave what doesn’t help. But for me, when I’m anxious, I tend to shallow breathe a lot. I hold my breath a lot. For me, it was just reminding myself just to breathe. Not breathe in any particular fashion or deep breathing, but just be like, “Take a breath, Kimberley, when you need. Take a breath when you need.”

TIP #4: WHAT TO DO WHEN HEALTH ANXIETY TAKES OVER?

Tip #4 is what to do when anxiety takes over in the biggest way, and that ultimately means, what can you do when your brain is setting on the full alarm. Now in this case, I’m just going to say it’s basically what to do if you’re panicking and the advice goes the same as it is whether there’s a health anxiety panic attack or a regular non-health anxiety panic attack, which is do not try to push the anxiety away. Let’s break it down.

If you’re having anxiety, and you are saying, “This is bad, I don’t want it, it shouldn’t be here,” you’re actually telling your brain that the anxiety is dangerous. Not just the health issue, but also the presence of anxiety is dangerous, which means it’s going to pump out more and more anxiety because you’ve told it that anxiety is dangerous. Your job here is to let the anxiety be there. Try not to push it away. What we know is what you try to push away comes stronger. 

You can talk to your anxiety. There’s actually research to show that when you talk to your anxiety and you talk to yourself in the third person, it can actually empower you and feel more of a sense of empowerment and mastery over that experience. For me, unfortunately, I’ve had quite the 24 hours. We actually had a very large earthquake last night here in southern California, which woke me up, so I had some anxiety related to that. And then of course, my brain was like, “Oh yeah, and by the way, you might have cancer. Ha-ha-ha!” You know what I mean? Of course, your brain’s going to tell you that. 

In that moment, I used the skill and the research around talking to myself in the third person. I said, “Kimberley, there’s nothing you can do right now. It makes total sense that you have anxiety. Let’s not push it away. Let’s bring your attention to what you can control, which is how kind you are to yourself, whether you’re clenching your body up, whether you’re breathing, whether what you’re putting your attention on. You can’t control anything. You can’t control this earthquake. You can’t control what’s happening tomorrow. All you can do is be here now.” Using a third person, using your name as the third person like, “Kimberley...” and saying what you need to do. Coaching yourself has been incredibly helpful for me and I know for a lot of people because that’s actually science-based. 

TIP #5: ENGAGE IN VALUE-BASED BEHAVIORS

The next thing I want you to do, and this is the final one before we go through some questions that I want you to ask yourself, is to engage in value-based behaviors. Now what that means is when we’re anxious, when we have health anxiety, it’s very normal for us to want to engage in safety behaviors. One for me was every morning, I drop my daughter off and my husband drops my son off at school and I could feel my anxiety wanting to stay home. I don’t want to go out. And so I almost was starting to say, “Maybe I’ll ask my husband to drop off my daughter and my son so I can stay home.” I recognize that would be me doing a fear-based behavior. I would be doing that only because I don’t want to face fear today. I just want to make it small. 

Number one, it’s okay. If you need to do that, that’s totally okay. But for me personally, I caught myself and I said, “No, you value being someone who drops off your daughter and shows up and doesn’t let anxiety win. You love dropping off your daughter. If you stayed home, you’d only be doing the dishes, circling around, maybe catastrophizing, just trying to get past time. You love taking your daughter to drop off.” And so engage in that. 

Another value-based behavior for me personally is humor. I’m texting friends and I’m telling them jokes about what I’m going to do to my doctor if he says something wrong or something, or I’m making jokes about some of the questions and statements that the nurses made. I’m making jokes about it, not to catastrophize, not to put them down, not to minimize my own discomfort, but humor is a very big part of my values. I’m making jokes about what we’ll do if it’s cancer and will you come to my funeral and silly things. Again, I really want to make sure you understand, I’m not doing that as depressed bad things are going to happen. I’m doing it because I’m literally saying, it will be what it will be. Let’s just move forward and let’s actually bring some light and joy and some laughter to this. 

Now you might not like that. If that’s not your values, don’t do it, but identify, what would the non-anxious me do right now? What would I do if this fear wasn’t here? And then do those behaviors. It’s really, really important that you make sure you hit this in as many ways as you can because fear can cause us just to clam up and sit still and ruminate. It’s very important that you practice not just ruminating and cycling and going over and over and over and over all of the worst-case scenarios because your brain will take you to some very dark places.

HEALTH ANXIETY JOURNAL PROMPTS

This is really important. I know I’ve given you the top five, but that’s more like 20 points. Let’s talk about some hypochondria or health anxiety journal prompts or questions you can ask yourself to stay as skilled as you can. 

  • What is in my control right now? 

What is in my control? My behaviors, my reactions. That’s ultimately what is in your control. What’s not in your control is how much anxiety you have and what thoughts you have about them. 

  • What is not in my control? 

You can be very specific here. In my case, it’s like, what’s not in my control is what the doctor says. What’s not in my control is what my health condition is. What’s not in my control is when he calls. You know what I mean? What’s not in my control is the treatment plan. I’m going to have to wait for him to do that. I’m identifying what is in my control and what is not. 

  • How am I going to gain a sense of control that is helpful to both my long-term health anxiety recovery goals and my health anxiety treatment plan? 

For me, I know that Googling is going to be a full sense of control and doesn’t help my long-term recovery, so I’m not going to do it. I know that me ruminating and doing tons of mental compulsions is going to give me a sense of control, but it’s not helpful. It’s not helpful. It doesn’t help my long-term recovery, it doesn’t help my long-term mental health, so I’m not going to do it. 

What will help my long-time health anxiety goals, it’s going to be all the tips that we covered today—no Googling, no checking faces, no reassurance seeking, no swaying the doctor, practicing my mindfulness, being as compassionate as I can, maybe taking some breaths. All of those are going to make me stronger in my health anxiety recovery instead of weaker the ones which would be ruminating and doing all of these. Not very helpful safety behaviors. 

  • How willing am I to be uncertain right now? 

You guys are going to have to tolerate a lot of uncertainty. That’s what this is all about. From the minute I got the call from that nurse saying that I needed to have this video appointment, from the minute he got onto the video appointment, all I had to focus on is, am I willing to be uncomfortable? Am I willing to be uncertain? Because the only reason I would’ve Googled was because I wanted certainty. Really, really important. 

  • What would the non-anxious me do right now? 

She’d get up and she’d go and drop her daughter off, and then she’d call your friend because that’s what you do every Wednesday morning. She’d respond to emails, she’d call. Do whatever it is that you’re doing. What would the non-anxious you do?

  • How can I be kind and gentle towards myself as I navigate this experience? 

Another code question for that is, what do I need right now that is skillful? What do you need? The most beautiful thing about this is my husband. He is the most gorgeous man. He sits down. He doesn’t reassure me, he just says, “I got you.” If your partner is giving you a lot of reassurance, you might want to mention to them, “That actually doesn’t help my long-term health anxiety. I just need you to be next to me and support me.” And so it’s very important that we make sure our partners aren’t giving us a whole bunch of reassurance and a whole bunch of certainty-seeking behaviors that keep us stuck. 

That’s it guys. There are my five tips for health anxiety which turned out to be more like 20, I know, but I try to always overdeliver. I really wanted to jam in as many skills as I could.

I hope you have a wonderful day. Please do not worry about me. I am actually fine. There’s a joke between my best friend and I. We say, “Are you fine number one or fine number two?” Fine number one is you actually are fine and fine number two is you’re not fine, but you’re saying you are, and I am fine number one. I actually have a lot of faith in my doctors. I have a lot of faith in my ability to handle these things and these are just another bump on the road in terms of being someone who has postural orthostatic tachycardic syndrome. So all is well. All is well. I am fine number one and I hope you are fine number one as well. 

I am sending you so much love. Do not forget, it is a beautiful day to do all the hard things, and I’ll see you next week.

Feb 10, 2023

5 TIPS FOR HEALTH ANXIETY DURING A DRS VISIT

If you want my five tips for health anxiety during a Drs visit, especially if you have a medical condition that concerns you, this is the episode for you.



Hello and welcome back everybody. Today, I’m going to share some updates about a recent medical issue I have had, and I’m going to share specific tips for dealing with health anxiety (also known as hypochondria). 

323 5 tips for health anxiety

A lot of you who have been here with me before know I have postural orthostatic tachycardic syndrome. I also have a lesion on my left cerebellum and many other ups and downs in my medical history where I’ve had to get really good at managing my health anxiety. I wanted to share with you some real-time tips that I am practicing as I deal with another medical illness or another medical concern that I wanted to share with you. 

Here I’m going to share with you five specific tips, but I think in total, there’s 20-something tips all woven in here. I’ve done my best to put them into just five. But do make sure you listen to the end of the podcast episode because I’m also going to give some health anxiety journal prompts or questions that you can ask yourself so that you can know how to deal with health anxiety if you’re experiencing that at this time. 

Before we get into it, let me give you a little bit of a backstory. Several months ago, I did share that I’ve been having these what I call surges. They’re like adrenaline surges. They wake me up. My heart isn’t racing. It’s not like it’s racing fast, but the only way I can explain it is I feel like I have like a racehorse’s heart in my chest, like this huge heart that’s beating really heavily. Of course, that creates anxiety. And so then I would question like, is it the heartbeat or is it just my anxiety? You go back and you go forward trying to figure out which is which. But because this was a symptom that was persisting and was also showing up when I wasn’t experiencing a lot of stress or anxiety, I thought the right thing to do is to go and see the doctor. 

WHAT HEALTH ANXIETY FEELS LIKE

Before we get started, be sure to make sure you’re not avoiding doctors. Make sure you’re not dismissing symptoms. We do have to find a very, very wise balance between avoiding doctors but also not overdoing it with doctors. We’ll talk about that a little bit here in a minute. But first, I wanted to just share with you what health anxiety feels like for me. Because for me, I’m very, very skilled at identifying what is anxiety and what is not. I’ve become very good at catching that by experience, folks. It’s not something that comes naturally, but by experience, I can identify what is health anxiety and what is a real medical condition or what is something worthy of me getting checked out. 

For me, for the health anxiety piece, it’s really this sort of anxiety that is a sense of catastrophization and it’s usually in the form of thoughts like, what if this is cancer? What if this is a stroke? All the worst-case scenarios. What if this is life-threatening? What if I miss this and you are responsible, you should have picked it up. These are very common health anxiety intrusive thoughts or health anxiety thoughts that I think you really need to be able to catch and be aware and mindful of. First of all, that is the biggest symptom for me. 

The other thing is when you have health anxiety, you do tend to hyper-fixate on the symptom and all of the surrounding symptoms that are going with that. And then you can really catastrophize those like, “Well, my heart’s beating really heavily and I feel dizzy. Oh my gosh. And I’ve been having a headache. Yeah, you’re right, I’ve been having a headache. Oh my gosh.” I call it ‘gathering.’ That’s not an actual clinical term, but I do use it with my clients. We gather data that is catastrophic to make it seem like, yeah, we actually have a really big point, and this is actually a catastrophe. 

Some other health anxiety symptom that I experience is panic. When you notice a symptom, it is very common to start panicking. And then again, you go back to this chicken or the egg or is it the horse or the carriage in terms of I’m panicking, and now the panic has all these symptoms. Are these symptoms an actual medical condition or are they actually just anxiety and panic? You could spend a lot of time stuck in that cycle trying to figure that out. 

Let’s now talk about how to manage these symptoms and some tips and tools that you can use. 

Tip #1: No Googling

Let me tell you what has recently happened to me. I’ve been having these symptoms. I made an appointment to see my cardiologist. It was two months out and I was like, “It’s not a big deal. I can handle these symptoms.” I’m feeling super confident about my ability now to just ride out some pretty uncomfortable sensations and not catastrophize. I go in for my checkup, they do an echocardiogram, and it’s taking a long time. She’s asking me these strange questions like, “Why are you here again,” as she’s doing it. She’s checking, she’s looking, she’s squinting at the screen. “Why are you here again? What are your symptoms?” Click, click, click, looking at the heart, whatever. Again, I’m in my mind going, “Kimberley, let your brain have whatever thoughts it wants. We’re not going to catastrophize.” I was doing really, really well. I got up and I answered her questions. I did the whole appointment. She cleaned me off when I was done and said, “Great, you’ve got 24 hours and then the doctor will email you with your results.”

And then yesterday afternoon, I get a call from the nurse saying, “We need to book you a video appointment with the doctor to discuss your results.” As you can imagine, my brain went berserk. My health anxiety thoughts were saying, “This is really bad. Why would he need to make a video appointment? This can only end badly. This must be cancer. This must be heart problems. Am I going to have a heart attack and so forth?” Of course, my brain did that. I’m grateful my brain does that because that’s my brain being highly functioning and aware. 

But the number one rule I made with myself in that exact moment, even though that was very anxiety-producing, is no Googling. Kimberley, you are not allowed to pick up the computer or the iPhone and Google anything about this.

That is tip #1 for you. I’ll tell you why. A lot of my patients say, “But why? It’s no harm. I’m not doing any harm.” And I’ll say, “Yes.” I’ve actually just seen my cardiologist. But now that I’ve had my appointment, he encouraged me to do a little research. What was hilarious to me is every single website is different and some catastrophize and some don’t. Some go, “This could be very normal.” Other ones say, “This could be cancer, cancer, cancer, cancer.”

This is why I’m telling my patients all the time, don’t Google because what you read is different. It’s not like this is going to be a factual thing. Most of the time people who have articles that rank high on Google searches are the ones who have optimized their website to be very easy to Google. The reason they have become number one on the Google algorithm is because they’ve included keywords like cancer for blah, blah, blah, and all of these health issues and health names. The ones that are at the top, some of them are very reasonable, helpful, and accurate, but a lot of them are not. They’ve just really done a great job of putting in lots and lots of keywords that makes them highly searchable and come up high on the algorithm.

Please, number one, do not Google. Go to your doctor for questions if you have any. Unless they’ve encouraged you to do research, do not Google.

TIP #2: FOLLOW IMPORTANT HEALTH ANXIETY CBT TECHNIQUES

I’ve actually categorized this in a bigger category and I’ve called it important health anxiety CBT techniques, because there are some important CBT tools that you’re going to need here and here we go. 

While I was in getting my echocardiogram, I was laying and I was having some anxiety because she was squinting and asking some strange questions, not in the normal of what I’d experienced. I could feel the pull to check her face for reassurance like, does she look concerned? Does she look relaxed? What’s going on with her? I wonder what she meant. 

What I want to encourage you to do is acknowledge and catch when you’re checking their face to try to decipher what the nurse or the assistant or the doctor is doing and saying. Because really, all I’m doing there is mind reading because I have no idea what she’s thinking. I was laughing at myself because she was squinting and looking concerned. I was like, “I wonder if she’s trying not to pass gas.” We could mind read that she thinks I have cancer and that there’s a big problem, or maybe she’s just trying not to pass gas right now. Maybe she’s thinking about a fight she just had with her partner. My attempt to analyze her facial expression is a complete waste of my time. You could use that tip anytime you want. 

The next tip for you is no reassurance seeking with nurses or doctors. Now, I actually felt almost into this trap. If I’m being completely honest, I did fall into this trap, but I caught myself really quickly. As she was finishing up, she took off her gloves and got ready to discharge me, and I said, “So, you’d let me know if there was...” I paused because what I was going to say is, “You’ll let me know if there’s something wrong, right?” I was going to say that. And then I was like, “No, no, no.” I stopped myself and said, “You know what? I know the deal. I’ve done these enough times. I know I have to wait for the doctor.” But I caught myself wanting to get confirmation from the nurse and I already know that nurses are not allowed to give me any diagnosis anyway. I caught myself wanting to get some expression of relief from her like, “No, you’re fine. Everything looks good,” or whatever. Sometimes they accidentally give you that reassurance. But I caught myself seeking reassurance from her. 

In addition to that—let me talk to you a little later about how we do that with doctors as well—often if you’re in the office with a doctor, you may find yourself at the end of the session going, “I’ll be fine, right? It’s not bad, right?” It’s okay, we’re all going to ask some of those questions. I’m not going to be the reassurance-seeking police with you. But what I want you to do is really drop down into catching when we’re engaging in reassurance seeking and using it too much to reduce our own anxiety about it, to take away our own anxiety or fear.

Now, another CBT technique or sort of rule that we often set in clinical work when I’m talking with my clients who have health anxiety is also not swaying the doctor or the nurse to answer things in the way that you want. A lot of people fall into this trap. For me, I just had my doctor’s appointment. We are working through and there are some little problems that we will work out. But I caught myself there wanting to sway him to be very positive. We had talked about it ultimately. He had said, “There are some issues. It could be this, it could be that, it could be this.” He listed off three or four options. Some were very, very small, and of course, the third one is always like, it could be cancer. They always say at the end, like whatever.

When they give you these three or four or five options on what the problem might be, it’s very important that you be mindful and aware of how you’re trying to sway the doctor to give you certainty. This is what my doctor said, and I’m going to be brief. I’m not going to bore you with my medical stuff, but he’ll say, “It could be that you recently had COVID or an illness or a virus. It could also be this other condition, which is common, and if it’s so, we’ll treat that. It could also be that there could be some rheumatoid arthritis and that’s a longer treatment. And then the final thing, which we don’t think so, but it also could be cancer. “Let’s say he lists off these four options. 

Now, this is very common. Doctors will do this often because their job is to educate us on all of the possibilities so that we can create a treatment plan that doesn’t ignore big issues, but we have to be careful that we don’t spend their time and our time going, “You think it’s the first one, right? It’s probably just the first one. I probably just had a virus, right?” I’m really swaying him towards giving an answer when he’s already told us that he or she doesn’t know yet. He’s already said, “I don’t know yet. We’re going to need to do extra tests.”

Catch yourself trying to get them to reassure you and confirm that it’s definitely not the C word. The cancer word is what I’m saying there. Catch yourself when you’re doing those behaviors in the office with either the nurses or the technician or the doctors. Very, very important. 

Now, one other thing I want you to also catch is if you’re coming to them with something, let’s say you are coming to them with a concern that you’ve pretty much know is your health anxiety, but you want reassurance that it’s not, also be careful that you don’t overly list things to convince them that something is wrong. A lot of you don’t do this, I know, but I have had a lot of clients who’ve come back to me after seeing the doctor and said, “Do you have any other symptoms,” and they would list even minor symptoms that they had a month ago that they knew had nothing to do with it. But they felt like if they didn’t say it all, if they didn’t include every symptom, every stomach ache, every headache, everything, they could miss something. So also keep an eye out for that.

That’s some sort of overall general CBT techniques we use for health anxiety that help guide people into not engaging in those health anxiety compulsions.

TIP #3: HEALTH ANXIETY HELP DURING YOUR DOCTOR’S VISIT

This is a really important part of it. From the minute that I got the call from the nurse that he wanted a video call with me, my mind went to, again, the worst-case scenario. It just does. It just does. I think that that is actually really, really normal. I really do. I think that is what happens naturally for anybody. First of all, I don’t want to even go too over in terms of pathologizing that. I think that’s a normal thing for anybody to experience. 

The first thing I want you to practice is validating your anxiety. It’s a part of self-compassion practice. It’s going, “It makes complete sense, Kimberley, that this is concerning you.” That’s one of the most important self-compassionate statements you could make for yourself. “It makes complete sense that this is hard, this is scary. Of course, it’s making you uncomfortable.” It’s validating. 

You might even move to a common humanity, going, “Anybody in this situation would have anxiety.” Then you can also move into mindfulness skills, which is—this was one that I hold very true—just because I feel anxious doesn’t mean there’s danger or there’s a catastrophe. It’s my body’s natural response to create anxiety when it feels threatened. That keeps me alive. That’s a good thing. But just because I’m anxious and having thoughts about scary things doesn’t mean they’re facts. Remember, thoughts are not facts.

The next thing here is also being able to just observe them, again, while you’re sitting in the waiting room. They were playing the movie, what’s it called? Moana. And I love Moana. I remember watching it as a child. I’m sitting in the seat and my mind is offering me all of these health anxiety intrusive thoughts, and my mind really wants me to pay attention to them. 

A part of my mindfulness practice was to go, “I am noticing I’m having these catastrophic thoughts, but I’m also noticing Moana, and I’m going to choose which one I give my attention to.” I’m not going to push them away. I’m not going to make the thoughts go away because they’re naturally going to be there. I basically knew from yesterday afternoon until 9:00 AM this morning that the thoughts were going to be there and I accepted them there. I didn’t go in saying, “Oh gosh, I hope the next 24 hours aren’t filled with thoughts.” I was like, they’re going to be, “Hello thoughts, welcome. I know you’re going to be here,” and I’m going to train my brain to put attention on what matters to me. In this case, I’m not going to make these thoughts important. I’m going to watch Moana. I’m going to look at the colors, I’m going to listen to the sounds, I’m going to notice whatever it is that I notice. I’m going to notice the fabric of the seat underneath me as I’m waiting in the room. Last night as I went to bed, I’m just going to notice the feeling of the cushions underneath me. This is mindfulness and this is so important—being present and paying attention to what is currently happening instead of the worst-case scenario.

There’s one important point here, which is my mind kept saying, “By nine o’clock tomorrow, your life might change.” You guys know what? If you’re listening, I’m guessing you know what that’s like. You’re like, “After this appointment, this appointment may change your life for the worse.” My job was to go, “Maybe, maybe not. It could be that he just wants to tell me everything’s okay.”

It is what it is. It will be what it will be. I will work through it and solve it when it happens. I’m not going to live the next 24 hours or the next 12 hours coming from a place of the worst-case scenario until I have actual evidence of that. So we are not going to live your life as you wait for your appointment. We’re not going to live your life through the lens of the worst case. We’re going to live through it through being uncertain and accepting that in this moment, nothing is wrong. Until we know, we don’t know. 

MEDITATION FOR HEALTH ANXIETY

Now, other options for you, I’m just going to add a couple here, is I have found meditation for health anxiety to be very, very helpful, particularly when health anxiety is taking over. That has been very beneficial for me—to find a meditation that can actually sometimes give me some concrete skills to use in the moment to stay present. We are not going towards staying calm because maybe you’re going to have some anxiety. That’s okay. Really what we want to do is we want to be working in the most skillful fashion as we can. 

And then the last one, this one’s a little controversial. Some people don’t agree with this piece of advice, so take what you need and leave what doesn’t help. But for me, when I’m anxious, I tend to shallow breathe a lot. I hold my breath a lot. For me, it was just reminding myself just to breathe. Not breathe in any particular fashion or deep breathing, but just be like, “Take a breath, Kimberley, when you need. Take a breath when you need.”

TIP #4: WHAT TO DO WHEN HEALTH ANXIETY TAKES OVER?

Tip #4 is what to do when anxiety takes over in the biggest way, and that ultimately means, what can you do when your brain is setting on the full alarm. Now in this case, I’m just going to say it’s basically what to do if you’re panicking and the advice goes the same as it is whether there’s a health anxiety panic attack or a regular non-health anxiety panic attack, which is do not try to push the anxiety away. Let’s break it down.

If you’re having anxiety, and you are saying, “This is bad, I don’t want it, it shouldn’t be here,” you’re actually telling your brain that the anxiety is dangerous. Not just the health issue, but also the presence of anxiety is dangerous, which means it’s going to pump out more and more anxiety because you’ve told it that anxiety is dangerous. Your job here is to let the anxiety be there. Try not to push it away. What we know is what you try to push away comes stronger. 

You can talk to your anxiety. There’s actually research to show that when you talk to your anxiety and you talk to yourself in the third person, it can actually empower you and feel more of a sense of empowerment and mastery over that experience. For me, unfortunately, I’ve had quite the 24 hours. We actually had a very large earthquake last night here in southern California, which woke me up, so I had some anxiety related to that. And then of course, my brain was like, “Oh yeah, and by the way, you might have cancer. Ha-ha-ha!” You know what I mean? Of course, your brain’s going to tell you that. 

In that moment, I used the skill and the research around talking to myself in the third person. I said, “Kimberley, there’s nothing you can do right now. It makes total sense that you have anxiety. Let’s not push it away. Let’s bring your attention to what you can control, which is how kind you are to yourself, whether you’re clenching your body up, whether you’re breathing, whether what you’re putting your attention on. You can’t control anything. You can’t control this earthquake. You can’t control what’s happening tomorrow. All you can do is be here now.” Using a third person, using your name as the third person like, “Kimberley...” and saying what you need to do. Coaching yourself has been incredibly helpful for me and I know for a lot of people because that’s actually science-based. 

TIP #5: ENGAGE IN VALUE-BASED BEHAVIORS

The next thing I want you to do, and this is the final one before we go through some questions that I want you to ask yourself, is to engage in value-based behaviors. Now what that means is when we’re anxious, when we have health anxiety, it’s very normal for us to want to engage in safety behaviors. One for me was every morning, I drop my daughter off and my husband drops my son off at school and I could feel my anxiety wanting to stay home. I don’t want to go out. And so I almost was starting to say, “Maybe I’ll ask my husband to drop off my daughter and my son so I can stay home.” I recognize that would be me doing a fear-based behavior. I would be doing that only because I don’t want to face fear today. I just want to make it small. 

Number one, it’s okay. If you need to do that, that’s totally okay. But for me personally, I caught myself and I said, “No, you value being someone who drops off your daughter and shows up and doesn’t let anxiety win. You love dropping off your daughter. If you stayed home, you’d only be doing the dishes, circling around, maybe catastrophizing, just trying to get past time. You love taking your daughter to drop off.” And so engage in that. 

Another value-based behavior for me personally is humor. I’m texting friends and I’m telling them jokes about what I’m going to do to my doctor if he says something wrong or something, or I’m making jokes about some of the questions and statements that the nurses made. I’m making jokes about it, not to catastrophize, not to put them down, not to minimize my own discomfort, but humor is a very big part of my values. I’m making jokes about what we’ll do if it’s cancer and will you come to my funeral and silly things. Again, I really want to make sure you understand, I’m not doing that as depressed bad things are going to happen. I’m doing it because I’m literally saying, it will be what it will be. Let’s just move forward and let’s actually bring some light and joy and some laughter to this. 

Now you might not like that. If that’s not your values, don’t do it, but identify, what would the non-anxious me do right now? What would I do if this fear wasn’t here? And then do those behaviors. It’s really, really important that you make sure you hit this in as many ways as you can because fear can cause us just to clam up and sit still and ruminate. It’s very important that you practice not just ruminating and cycling and going over and over and over and over all of the worst-case scenarios because your brain will take you to some very dark places.

HEALTH ANXIETY JOURNAL PROMPTS

This is really important. I know I’ve given you the top five, but that’s more like 20 points. Let’s talk about some hypochondria or health anxiety journal prompts or questions you can ask yourself to stay as skilled as you can. 

  • What is in my control right now? 

What is in my control? My behaviors, my reactions. That’s ultimately what is in your control. What’s not in your control is how much anxiety you have and what thoughts you have about them. 

  • What is not in my control? 

You can be very specific here. In my case, it’s like, what’s not in my control is what the doctor says. What’s not in my control is what my health condition is. What’s not in my control is when he calls. You know what I mean? What’s not in my control is the treatment plan. I’m going to have to wait for him to do that. I’m identifying what is in my control and what is not. 

  • How am I going to gain a sense of control that is helpful to both my long-term health anxiety recovery goals and my health anxiety treatment plan? 

For me, I know that Googling is going to be a full sense of control and doesn’t help my long-term recovery, so I’m not going to do it. I know that me ruminating and doing tons of mental compulsions is going to give me a sense of control, but it’s not helpful. It’s not helpful. It doesn’t help my long-term recovery, it doesn’t help my long-term mental health, so I’m not going to do it. 

What will help my long-time health anxiety goals, it’s going to be all the tips that we covered today—no Googling, no checking faces, no reassurance seeking, no swaying the doctor, practicing my mindfulness, being as compassionate as I can, maybe taking some breaths. All of those are going to make me stronger in my health anxiety recovery instead of weaker the ones which would be ruminating and doing all of these. Not very helpful safety behaviors. 

  • How willing am I to be uncertain right now? 

You guys are going to have to tolerate a lot of uncertainty. That’s what this is all about. From the minute I got the call from that nurse saying that I needed to have this video appointment, from the minute he got onto the video appointment, all I had to focus on is, am I willing to be uncomfortable? Am I willing to be uncertain? Because the only reason I would’ve Googled was because I wanted certainty. Really, really important. 

  • What would the non-anxious me do right now? 

She’d get up and she’d go and drop her daughter off, and then she’d call your friend because that’s what you do every Wednesday morning. She’d respond to emails, she’d call. Do whatever it is that you’re doing. What would the non-anxious you do?

  • How can I be kind and gentle towards myself as I navigate this experience? 

Another code question for that is, what do I need right now that is skillful? What do you need? The most beautiful thing about this is my husband. He is the most gorgeous man. He sits down. He doesn’t reassure me, he just says, “I got you.” If your partner is giving you a lot of reassurance, you might want to mention to them, “That actually doesn’t help my long-term health anxiety. I just need you to be next to me and support me.” And so it’s very important that we make sure our partners aren’t giving us a whole bunch of reassurance and a whole bunch of certainty-seeking behaviors that keep us stuck. 

That’s it guys. There are my five tips for health anxiety which turned out to be more like 20, I know, but I try to always overdeliver. I really wanted to jam in as many skills as I could.

I hope you have a wonderful day. Please do not worry about me. I am actually fine. There’s a joke between my best friend and I. We say, “Are you fine number one or fine number two?” Fine number one is you actually are fine and fine number two is you’re not fine, but you’re saying you are, and I am fine number one. I actually have a lot of faith in my doctors. I have a lot of faith in my ability to handle these things and these are just another bump on the road in terms of being someone who has postural orthostatic tachycardic syndrome. So all is well. All is well. I am fine number one and I hope you are fine number one as well. 

I am sending you so much love. Do not forget, it is a beautiful day to do all the hard things, and I’ll see you next week.

Feb 3, 2023

Today, we’re talking about the Top 5 Relationship Rules I have that have changed my life. This episode was inspired by a letter I wrote to all of you. For those of you who signed up for my newsletter, I give you tools and tips, and stories, and I tell you funny jokes sometimes. But I was writing the newsletter while I was in Australia just before I left when I was there in December, and I was reflecting on how beautiful my relationships are with my family now. And I was reflecting on why. Why are they so beautiful? Well, number one, they’re beautiful people. But number two, more importantly, I have learned these relationship rules, which have allowed me to have the most beautiful relationship with my family and the most beautiful relationship with my husband, my kids, my friends, and you guys.



Now, that doesn’t mean there are no bumps. That doesn’t mean there are no arguments. A few weeks ago, I wrote in the newsletter about how I had an argument with my husband. Of course, I was joking about how wrong he was and how right I was. But it doesn’t mean we don’t have conflict, but we get to coexist because of these relationship rules, and I want to share them with you. 

Before we proceed, I want to say, these mightn’t work for you. I think they work well, but I don’t want you to feel guilty, ashamed, embarrassed, angry, or whatever the feelings are if you feel like these don’t match you. So take what you need here. Leave what isn’t helpful for you; if it’s useful for you, wonderful. If it doesn’t sit right, one of them doesn’t sit right, that is not a problem. It’s totally okay to use what helps you. When I’m talking on this podcast, I’m giving you ideas, so be curious and consider them, but it doesn’t mean that I’m always right, I think I’m right, or I know what’s right for you. 

All right, here we go. I’m going to go through them quickly and then elaborate a little later once we get through, okay? But I want to remind you that these relationship rules help me stay solid in my relationships, and they’ve gotten me through some of the hardest periods and seasons of my life. So, let’s see if they’re helpful for you. 

Ep. 322 5 Relationship rules that have changed my life

1. It is not your job or my job to manage our family’s emotions. 

Their emotions are their responsibility, and it is their job to regulate their emotions when they’re upset with us. And it’s our job to regulate and manage our emotions when we are upset. Now, what does regulate mean? It means you’re allowed to have them. We’re not saying that no one’s allowed to be upset, but we have to communicate and share with them and regulate by not throwing things, lashing out, saying unkind things, saying things that aren’t true, saying ‘you’ statements like, “You’re so blah, blah, blah.” We want to use ‘I’ statements like, “I feel this way about that,” or “I would like this thing to happen.” So, we want to regulate as best as we can. Our job is to regulate what shows up for us, and their job is to regulate what shows up for them. 

2. It is not your job to please the people you are in relationship with.

Now, they get to have expectations and they get to communicate with you on what their expectations are, and you get to have expectations and you get to communicate their expectations. Now, this is so important, then we can have a respectful conversation. A lot of the time these days, I see people in relationships or even online where somebody disagrees and they’re so hurt. They’re like, “You’ve harmed me by saying that. I’m so hurt by what you said.” But the person gets to have their thoughts and their feelings. It’s not our job to manage it, and it’s not our job to please them either. So you get to have your beliefs and thoughts and ideas, and you get to disagree with other people as well. It’s as long as we’re able to do it respectfully. And when I say respectful, I’m not saying it in a people-pleasing way either. It is not our job to please people. It’s just not. 

Here’s a deeper one. Let me just jump into this a little: I’m still working on this and I get therapy. I have a lot of practice and I’ve read about the idea of my happiness. That’s my job. My happiness is my job. And I easily get caught up in, “No, if my partner would just do A, B, and C, then I can be happy,” or “If my kids just do A, B, and C, then I can be happy.” And that is true to a degree. But the problem with that rule, if you want to keep that rule, is you have no empowerment and no responsibility. It’s all up to them. Your life is in their hands. Your happiness is in their hands. 

And so, I like to think about, yeah, people can’t always please me, like I just said, and people are going to upset me. And then it’s my job to decide what I want to do with that, and it’s my job to determine how I’m going to cope today with the fact that they may not be living up to the way I want them to. So that’s really important. 

3. They are allowed to have their feelings about our choices. 

This is a big one for my husband and I. We say this to each other all the time. It’s like, “You’re allowed to have your feelings about that and so am I.” This one is so hard for me, especially in my marriage because if I upset him, I’d be like, “You shouldn’t be upset.” And he’s like, “I’m allowed to be upset. I’m allowed to have my feelings about it.” And I’m like, “No, but you shouldn’t.” And he’s like, “Yeah, but I am. I do.”

It is okay if they don’t like everything about us and if they disagree. It is our job to live according to our values, which doesn’t always align with their expectations of us. Our job is to go and live our lives and let them have their feelings about it. Then, we can communicate respectfully about our misalignment. “But that has been so beautiful for me.” To say, “You’re allowed to have your feelings about me, specifically me as a public person.” When I used to speak at a conference, or online or on Instagram, and someone would say something negative, I used to be like, “Oh, how dare they say something so mean? How could they disagree with me or not like me?” It was so painful because I had made this rule that they should only have good feelings about me. 

And now I’m okay. You can have all your feelings about me. You might like me, or you might hate me. You might like me one day and not like me the next. You might agree or not agree, and you get to have your feelings about me. I give you permission. It is so freeing to say, “I’m going to let everyone have permission to have their feelings about me.” That’s okay. I’m not for everyone. That sentence literally has healed me on the deepest level, probably more than any sentence. You’re allowed to have your feelings about me. So important.

4. It is okay if they struggle to understand us. 

In fact, I encourage you to accept that they will not always understand us. Sometimes people won’t have the capacity to understand us, and that doesn’t make us wrong. And it also doesn’t mean that you won’t be able to find a way to coexist and still love each other unconditionally. That’s so true. 

I always tell my patients, let’s say I come in and I’m wearing my favorite boots, which are a bit sassy, and you come in, and you’re like, “I hate your boots. They’re the ugliest boots ever.” I could even say, “Ah, you’re supposed to love my boots.” Or I could say, “That’s cool. You don’t have to love my boots. You get to have your feelings about them. And it’s okay if you don’t understand how rocking my boots are.” 

Now, this also goes for who you are. They get to have their feelings about who you are. They get to not like who we are, as long as they’re respectful, they don’t cross any boundaries, and they’re not abusive. They get to be upset, and it’s okay that they don’t understand us. As I said, some people can’t understand us. So important.

5. You get to (and they get to) change their mind or change, period. 

Again, this one was so hard for me. Now, for those of you who don’t know me, I’ve been married almost 20 years. It will be 20 years this year, which means my husband’s done a ton of changing, and so have my family, my friends, and so have you guys. There’s a lot of change. But they get to change. If somebody changes, we can’t go, “Wait, that’s not fair. I didn’t go into this relationship with you being this new version of you. You have to be the old version of you.” That’s not a real relationship. That’s saying you must stay the same and can’t express and be who you are. 

We could say, “You’ve changed, and these are my feelings about it,” as long as I’m doing it, not in a judgmental way or not in a way that’s trying to change them back because people get to change. They get to change their mind. So that’s another big one for me, is if someone says, “I like this,” and then they come back and say, “I actually really don’t,” I have to remind myself they’re allowed to change their mind because they’re allowed to have their feelings. And it’s okay that they don’t understand us, and they’re going to manage their own emotions, and I’m going to manage mine. 

We can’t hold ourselves to the expectation that will never change. As we go through different seasons in our life, we will change. And that might feel scary. But we can try using our mindfulness skills and our regulation skills to navigate the change and the emotions you have to feel. 

So those are the five relationship rules that have changed my life. Now, here’s the kicker. None of it is fun. None of it. This is some hard work. I nearly said that S word, which is fine. I’m allowed to swear, but it’s some hard shit. This is some terrible stuff to work through, but with it comes stronger and more unconditionally loving relationships. 

When I gave my husband permission to have his feelings about me, he was happier, and he loved me more because it meant that he didn’t have to pretend to be somebody else or he didn’t have to pretend to like something and get resentful because he actually didn’t like it. When I allowed myself to be different from my family, and I accepted that they might have feelings about that, and I gave them permission to have feelings about that, there wasn’t a problem anymore. 

The biggest problem, the biggest pain, the most suffering came when I was like, “No, they shouldn’t feel this way about me. That’s not fair”! But, it is fair. They get to have their feelings based on their own personal and their upbringing and their own incapacities and their own limitations. They get to have their feelings. It mightn’t be perfect, but I’m not perfect. 

You guys, I could add a fifth or sixth one here. I didn’t write this one in the email, but  I’m not perfect, and neither are they, and that’s okay. Sometimes I would say, “No, but they need to be this way because that’s the right way. This is the right way to be.” And I get it. Yeah, there is sometimes real right and wrong, like you shouldn’t harm people or say horrible things or critical things or racist things or misogynist things. We get that, and I agree with all that. But at the end of the day, the people in our lives will be imperfect, and we have to get better about not being black and white and cutting them off because they did a “bad” thing. 

I think cancel culture has taught us a lot in this idea of like, “You’re dead to me. You’re done. You’re canceled.”  Relationships don’t work like that. We’re human beings. We make mistakes. I’ve made a million mistakes. I’ve actually-- okay, now I’m going on and on. But we also have to learn to accept that we make mistakes and be willing to apologize for it. It’s a humble thing to do. It’s not fun, not fun at all, but we can also say we’re sorry too. 

So that’s it, you guys. There’s a humbling; there’s a humanity that we connect with when we can allow everyone to have their feelings, when we can allow ourselves to have our feelings when we can have limits and boundaries and clearly communicate that with our loved ones, but then also understand that sometimes they may not get it. 

Now there will be situations if you say, “I don’t like that,” and they will not respect you. You may need to make a limit and a boundary with them where they don’t have as much access to you. That’s 100% valid. And again, I’m not here telling you to accept other people’s bad behavior. Absolutely not. But we can accept that they have some feelings about it, as long as they’re communicating respectfully, kindly, compassionately, or at least they’re trying. At least they’re trying. 

So that’s it, folks. The five relationship rules that have literally changed my life and my relationships. I hope it’s helpful. It is a beautiful day to do hard things, and I will see you next week.

Feb 3, 2023

Today, we’re talking about the Top 5 Relationship Rules I have that have changed my life. This episode was inspired by a letter I wrote to all of you. For those of you who signed up for my newsletter, I give you tools and tips, and stories, and I tell you funny jokes sometimes. But I was writing the newsletter while I was in Australia just before I left when I was there in December, and I was reflecting on how beautiful my relationships are with my family now. And I was reflecting on why. Why are they so beautiful? Well, number one, they’re beautiful people. But number two, more importantly, I have learned these relationship rules, which have allowed me to have the most beautiful relationship with my family and the most beautiful relationship with my husband, my kids, my friends, and you guys.



Now, that doesn’t mean there are no bumps. That doesn’t mean there are no arguments. A few weeks ago, I wrote in the newsletter about how I had an argument with my husband. Of course, I was joking about how wrong he was and how right I was. But it doesn’t mean we don’t have conflict, but we get to coexist because of these relationship rules, and I want to share them with you. 

Before we proceed, I want to say, these mightn’t work for you. I think they work well, but I don’t want you to feel guilty, ashamed, embarrassed, angry, or whatever the feelings are if you feel like these don’t match you. So take what you need here. Leave what isn’t helpful for you; if it’s useful for you, wonderful. If it doesn’t sit right, one of them doesn’t sit right, that is not a problem. It’s totally okay to use what helps you. When I’m talking on this podcast, I’m giving you ideas, so be curious and consider them, but it doesn’t mean that I’m always right, I think I’m right, or I know what’s right for you. 

All right, here we go. I’m going to go through them quickly and then elaborate a little later once we get through, okay? But I want to remind you that these relationship rules help me stay solid in my relationships, and they’ve gotten me through some of the hardest periods and seasons of my life. So, let’s see if they’re helpful for you. 

Ep. 322 5 Relationship rules that have changed my life

1. It is not your job or my job to manage our family’s emotions. 

Their emotions are their responsibility, and it is their job to regulate their emotions when they’re upset with us. And it’s our job to regulate and manage our emotions when we are upset. Now, what does regulate mean? It means you’re allowed to have them. We’re not saying that no one’s allowed to be upset, but we have to communicate and share with them and regulate by not throwing things, lashing out, saying unkind things, saying things that aren’t true, saying ‘you’ statements like, “You’re so blah, blah, blah.” We want to use ‘I’ statements like, “I feel this way about that,” or “I would like this thing to happen.” So, we want to regulate as best as we can. Our job is to regulate what shows up for us, and their job is to regulate what shows up for them. 

2. It is not your job to please the people you are in relationship with.

Now, they get to have expectations and they get to communicate with you on what their expectations are, and you get to have expectations and you get to communicate their expectations. Now, this is so important, then we can have a respectful conversation. A lot of the time these days, I see people in relationships or even online where somebody disagrees and they’re so hurt. They’re like, “You’ve harmed me by saying that. I’m so hurt by what you said.” But the person gets to have their thoughts and their feelings. It’s not our job to manage it, and it’s not our job to please them either. So you get to have your beliefs and thoughts and ideas, and you get to disagree with other people as well. It’s as long as we’re able to do it respectfully. And when I say respectful, I’m not saying it in a people-pleasing way either. It is not our job to please people. It’s just not. 

Here’s a deeper one. Let me just jump into this a little: I’m still working on this and I get therapy. I have a lot of practice and I’ve read about the idea of my happiness. That’s my job. My happiness is my job. And I easily get caught up in, “No, if my partner would just do A, B, and C, then I can be happy,” or “If my kids just do A, B, and C, then I can be happy.” And that is true to a degree. But the problem with that rule, if you want to keep that rule, is you have no empowerment and no responsibility. It’s all up to them. Your life is in their hands. Your happiness is in their hands. 

And so, I like to think about, yeah, people can’t always please me, like I just said, and people are going to upset me. And then it’s my job to decide what I want to do with that, and it’s my job to determine how I’m going to cope today with the fact that they may not be living up to the way I want them to. So that’s really important. 

3. They are allowed to have their feelings about our choices. 

This is a big one for my husband and I. We say this to each other all the time. It’s like, “You’re allowed to have your feelings about that and so am I.” This one is so hard for me, especially in my marriage because if I upset him, I’d be like, “You shouldn’t be upset.” And he’s like, “I’m allowed to be upset. I’m allowed to have my feelings about it.” And I’m like, “No, but you shouldn’t.” And he’s like, “Yeah, but I am. I do.”

It is okay if they don’t like everything about us and if they disagree. It is our job to live according to our values, which doesn’t always align with their expectations of us. Our job is to go and live our lives and let them have their feelings about it. Then, we can communicate respectfully about our misalignment. “But that has been so beautiful for me.” To say, “You’re allowed to have your feelings about me, specifically me as a public person.” When I used to speak at a conference, or online or on Instagram, and someone would say something negative, I used to be like, “Oh, how dare they say something so mean? How could they disagree with me or not like me?” It was so painful because I had made this rule that they should only have good feelings about me. 

And now I’m okay. You can have all your feelings about me. You might like me, or you might hate me. You might like me one day and not like me the next. You might agree or not agree, and you get to have your feelings about me. I give you permission. It is so freeing to say, “I’m going to let everyone have permission to have their feelings about me.” That’s okay. I’m not for everyone. That sentence literally has healed me on the deepest level, probably more than any sentence. You’re allowed to have your feelings about me. So important.

4. It is okay if they struggle to understand us. 

In fact, I encourage you to accept that they will not always understand us. Sometimes people won’t have the capacity to understand us, and that doesn’t make us wrong. And it also doesn’t mean that you won’t be able to find a way to coexist and still love each other unconditionally. That’s so true. 

I always tell my patients, let’s say I come in and I’m wearing my favorite boots, which are a bit sassy, and you come in, and you’re like, “I hate your boots. They’re the ugliest boots ever.” I could even say, “Ah, you’re supposed to love my boots.” Or I could say, “That’s cool. You don’t have to love my boots. You get to have your feelings about them. And it’s okay if you don’t understand how rocking my boots are.” 

Now, this also goes for who you are. They get to have their feelings about who you are. They get to not like who we are, as long as they’re respectful, they don’t cross any boundaries, and they’re not abusive. They get to be upset, and it’s okay that they don’t understand us. As I said, some people can’t understand us. So important.

5. You get to (and they get to) change their mind or change, period. 

Again, this one was so hard for me. Now, for those of you who don’t know me, I’ve been married almost 20 years. It will be 20 years this year, which means my husband’s done a ton of changing, and so have my family, my friends, and so have you guys. There’s a lot of change. But they get to change. If somebody changes, we can’t go, “Wait, that’s not fair. I didn’t go into this relationship with you being this new version of you. You have to be the old version of you.” That’s not a real relationship. That’s saying you must stay the same and can’t express and be who you are. 

We could say, “You’ve changed, and these are my feelings about it,” as long as I’m doing it, not in a judgmental way or not in a way that’s trying to change them back because people get to change. They get to change their mind. So that’s another big one for me, is if someone says, “I like this,” and then they come back and say, “I actually really don’t,” I have to remind myself they’re allowed to change their mind because they’re allowed to have their feelings. And it’s okay that they don’t understand us, and they’re going to manage their own emotions, and I’m going to manage mine. 

We can’t hold ourselves to the expectation that will never change. As we go through different seasons in our life, we will change. And that might feel scary. But we can try using our mindfulness skills and our regulation skills to navigate the change and the emotions you have to feel. 

So those are the five relationship rules that have changed my life. Now, here’s the kicker. None of it is fun. None of it. This is some hard work. I nearly said that S word, which is fine. I’m allowed to swear, but it’s some hard shit. This is some terrible stuff to work through, but with it comes stronger and more unconditionally loving relationships. 

When I gave my husband permission to have his feelings about me, he was happier, and he loved me more because it meant that he didn’t have to pretend to be somebody else or he didn’t have to pretend to like something and get resentful because he actually didn’t like it. When I allowed myself to be different from my family, and I accepted that they might have feelings about that, and I gave them permission to have feelings about that, there wasn’t a problem anymore. 

The biggest problem, the biggest pain, the most suffering came when I was like, “No, they shouldn’t feel this way about me. That’s not fair”! But, it is fair. They get to have their feelings based on their own personal and their upbringing and their own incapacities and their own limitations. They get to have their feelings. It mightn’t be perfect, but I’m not perfect. 

You guys, I could add a fifth or sixth one here. I didn’t write this one in the email, but  I’m not perfect, and neither are they, and that’s okay. Sometimes I would say, “No, but they need to be this way because that’s the right way. This is the right way to be.” And I get it. Yeah, there is sometimes real right and wrong, like you shouldn’t harm people or say horrible things or critical things or racist things or misogynist things. We get that, and I agree with all that. But at the end of the day, the people in our lives will be imperfect, and we have to get better about not being black and white and cutting them off because they did a “bad” thing. 

I think cancel culture has taught us a lot in this idea of like, “You’re dead to me. You’re done. You’re canceled.”  Relationships don’t work like that. We’re human beings. We make mistakes. I’ve made a million mistakes. I’ve actually-- okay, now I’m going on and on. But we also have to learn to accept that we make mistakes and be willing to apologize for it. It’s a humble thing to do. It’s not fun, not fun at all, but we can also say we’re sorry too. 

So that’s it, you guys. There’s a humbling; there’s a humanity that we connect with when we can allow everyone to have their feelings, when we can allow ourselves to have our feelings when we can have limits and boundaries and clearly communicate that with our loved ones, but then also understand that sometimes they may not get it. 

Now there will be situations if you say, “I don’t like that,” and they will not respect you. You may need to make a limit and a boundary with them where they don’t have as much access to you. That’s 100% valid. And again, I’m not here telling you to accept other people’s bad behavior. Absolutely not. But we can accept that they have some feelings about it, as long as they’re communicating respectfully, kindly, compassionately, or at least they’re trying. At least they’re trying. 

So that’s it, folks. The five relationship rules that have literally changed my life and my relationships. I hope it’s helpful. It is a beautiful day to do hard things, and I will see you next week.

Feb 3, 2023

Today, we’re talking about the Top 5 Relationship Rules I have that have changed my life. This episode was inspired by a letter I wrote to all of you. For those of you who signed up for my newsletter, I give you tools and tips, and stories, and I tell you funny jokes sometimes. But I was writing the newsletter while I was in Australia just before I left when I was there in December, and I was reflecting on how beautiful my relationships are with my family now. And I was reflecting on why. Why are they so beautiful? Well, number one, they’re beautiful people. But number two, more importantly, I have learned these relationship rules, which have allowed me to have the most beautiful relationship with my family and the most beautiful relationship with my husband, my kids, my friends, and you guys.



Now, that doesn’t mean there are no bumps. That doesn’t mean there are no arguments. A few weeks ago, I wrote in the newsletter about how I had an argument with my husband. Of course, I was joking about how wrong he was and how right I was. But it doesn’t mean we don’t have conflict, but we get to coexist because of these relationship rules, and I want to share them with you. 

Before we proceed, I want to say, these mightn’t work for you. I think they work well, but I don’t want you to feel guilty, ashamed, embarrassed, angry, or whatever the feelings are if you feel like these don’t match you. So take what you need here. Leave what isn’t helpful for you; if it’s useful for you, wonderful. If it doesn’t sit right, one of them doesn’t sit right, that is not a problem. It’s totally okay to use what helps you. When I’m talking on this podcast, I’m giving you ideas, so be curious and consider them, but it doesn’t mean that I’m always right, I think I’m right, or I know what’s right for you. 

All right, here we go. I’m going to go through them quickly and then elaborate a little later once we get through, okay? But I want to remind you that these relationship rules help me stay solid in my relationships, and they’ve gotten me through some of the hardest periods and seasons of my life. So, let’s see if they’re helpful for you. 

Ep. 322 5 Relationship rules that have changed my life

1. It is not your job or my job to manage our family’s emotions. 

Their emotions are their responsibility, and it is their job to regulate their emotions when they’re upset with us. And it’s our job to regulate and manage our emotions when we are upset. Now, what does regulate mean? It means you’re allowed to have them. We’re not saying that no one’s allowed to be upset, but we have to communicate and share with them and regulate by not throwing things, lashing out, saying unkind things, saying things that aren’t true, saying ‘you’ statements like, “You’re so blah, blah, blah.” We want to use ‘I’ statements like, “I feel this way about that,” or “I would like this thing to happen.” So, we want to regulate as best as we can. Our job is to regulate what shows up for us, and their job is to regulate what shows up for them. 

2. It is not your job to please the people you are in relationship with.

Now, they get to have expectations and they get to communicate with you on what their expectations are, and you get to have expectations and you get to communicate their expectations. Now, this is so important, then we can have a respectful conversation. A lot of the time these days, I see people in relationships or even online where somebody disagrees and they’re so hurt. They’re like, “You’ve harmed me by saying that. I’m so hurt by what you said.” But the person gets to have their thoughts and their feelings. It’s not our job to manage it, and it’s not our job to please them either. So you get to have your beliefs and thoughts and ideas, and you get to disagree with other people as well. It’s as long as we’re able to do it respectfully. And when I say respectful, I’m not saying it in a people-pleasing way either. It is not our job to please people. It’s just not. 

Here’s a deeper one. Let me just jump into this a little: I’m still working on this and I get therapy. I have a lot of practice and I’ve read about the idea of my happiness. That’s my job. My happiness is my job. And I easily get caught up in, “No, if my partner would just do A, B, and C, then I can be happy,” or “If my kids just do A, B, and C, then I can be happy.” And that is true to a degree. But the problem with that rule, if you want to keep that rule, is you have no empowerment and no responsibility. It’s all up to them. Your life is in their hands. Your happiness is in their hands. 

And so, I like to think about, yeah, people can’t always please me, like I just said, and people are going to upset me. And then it’s my job to decide what I want to do with that, and it’s my job to determine how I’m going to cope today with the fact that they may not be living up to the way I want them to. So that’s really important. 

3. They are allowed to have their feelings about our choices. 

This is a big one for my husband and I. We say this to each other all the time. It’s like, “You’re allowed to have your feelings about that and so am I.” This one is so hard for me, especially in my marriage because if I upset him, I’d be like, “You shouldn’t be upset.” And he’s like, “I’m allowed to be upset. I’m allowed to have my feelings about it.” And I’m like, “No, but you shouldn’t.” And he’s like, “Yeah, but I am. I do.”

It is okay if they don’t like everything about us and if they disagree. It is our job to live according to our values, which doesn’t always align with their expectations of us. Our job is to go and live our lives and let them have their feelings about it. Then, we can communicate respectfully about our misalignment. “But that has been so beautiful for me.” To say, “You’re allowed to have your feelings about me, specifically me as a public person.” When I used to speak at a conference, or online or on Instagram, and someone would say something negative, I used to be like, “Oh, how dare they say something so mean? How could they disagree with me or not like me?” It was so painful because I had made this rule that they should only have good feelings about me. 

And now I’m okay. You can have all your feelings about me. You might like me, or you might hate me. You might like me one day and not like me the next. You might agree or not agree, and you get to have your feelings about me. I give you permission. It is so freeing to say, “I’m going to let everyone have permission to have their feelings about me.” That’s okay. I’m not for everyone. That sentence literally has healed me on the deepest level, probably more than any sentence. You’re allowed to have your feelings about me. So important.

4. It is okay if they struggle to understand us. 

In fact, I encourage you to accept that they will not always understand us. Sometimes people won’t have the capacity to understand us, and that doesn’t make us wrong. And it also doesn’t mean that you won’t be able to find a way to coexist and still love each other unconditionally. That’s so true. 

I always tell my patients, let’s say I come in and I’m wearing my favorite boots, which are a bit sassy, and you come in, and you’re like, “I hate your boots. They’re the ugliest boots ever.” I could even say, “Ah, you’re supposed to love my boots.” Or I could say, “That’s cool. You don’t have to love my boots. You get to have your feelings about them. And it’s okay if you don’t understand how rocking my boots are.” 

Now, this also goes for who you are. They get to have their feelings about who you are. They get to not like who we are, as long as they’re respectful, they don’t cross any boundaries, and they’re not abusive. They get to be upset, and it’s okay that they don’t understand us. As I said, some people can’t understand us. So important.

5. You get to (and they get to) change their mind or change, period. 

Again, this one was so hard for me. Now, for those of you who don’t know me, I’ve been married almost 20 years. It will be 20 years this year, which means my husband’s done a ton of changing, and so have my family, my friends, and so have you guys. There’s a lot of change. But they get to change. If somebody changes, we can’t go, “Wait, that’s not fair. I didn’t go into this relationship with you being this new version of you. You have to be the old version of you.” That’s not a real relationship. That’s saying you must stay the same and can’t express and be who you are. 

We could say, “You’ve changed, and these are my feelings about it,” as long as I’m doing it, not in a judgmental way or not in a way that’s trying to change them back because people get to change. They get to change their mind. So that’s another big one for me, is if someone says, “I like this,” and then they come back and say, “I actually really don’t,” I have to remind myself they’re allowed to change their mind because they’re allowed to have their feelings. And it’s okay that they don’t understand us, and they’re going to manage their own emotions, and I’m going to manage mine. 

We can’t hold ourselves to the expectation that will never change. As we go through different seasons in our life, we will change. And that might feel scary. But we can try using our mindfulness skills and our regulation skills to navigate the change and the emotions you have to feel. 

So those are the five relationship rules that have changed my life. Now, here’s the kicker. None of it is fun. None of it. This is some hard work. I nearly said that S word, which is fine. I’m allowed to swear, but it’s some hard shit. This is some terrible stuff to work through, but with it comes stronger and more unconditionally loving relationships. 

When I gave my husband permission to have his feelings about me, he was happier, and he loved me more because it meant that he didn’t have to pretend to be somebody else or he didn’t have to pretend to like something and get resentful because he actually didn’t like it. When I allowed myself to be different from my family, and I accepted that they might have feelings about that, and I gave them permission to have feelings about that, there wasn’t a problem anymore. 

The biggest problem, the biggest pain, the most suffering came when I was like, “No, they shouldn’t feel this way about me. That’s not fair”! But, it is fair. They get to have their feelings based on their own personal and their upbringing and their own incapacities and their own limitations. They get to have their feelings. It mightn’t be perfect, but I’m not perfect. 

You guys, I could add a fifth or sixth one here. I didn’t write this one in the email, but  I’m not perfect, and neither are they, and that’s okay. Sometimes I would say, “No, but they need to be this way because that’s the right way. This is the right way to be.” And I get it. Yeah, there is sometimes real right and wrong, like you shouldn’t harm people or say horrible things or critical things or racist things or misogynist things. We get that, and I agree with all that. But at the end of the day, the people in our lives will be imperfect, and we have to get better about not being black and white and cutting them off because they did a “bad” thing. 

I think cancel culture has taught us a lot in this idea of like, “You’re dead to me. You’re done. You’re canceled.”  Relationships don’t work like that. We’re human beings. We make mistakes. I’ve made a million mistakes. I’ve actually-- okay, now I’m going on and on. But we also have to learn to accept that we make mistakes and be willing to apologize for it. It’s a humble thing to do. It’s not fun, not fun at all, but we can also say we’re sorry too. 

So that’s it, you guys. There’s a humbling; there’s a humanity that we connect with when we can allow everyone to have their feelings, when we can allow ourselves to have our feelings when we can have limits and boundaries and clearly communicate that with our loved ones, but then also understand that sometimes they may not get it. 

Now there will be situations if you say, “I don’t like that,” and they will not respect you. You may need to make a limit and a boundary with them where they don’t have as much access to you. That’s 100% valid. And again, I’m not here telling you to accept other people’s bad behavior. Absolutely not. But we can accept that they have some feelings about it, as long as they’re communicating respectfully, kindly, compassionately, or at least they’re trying. At least they’re trying. 

So that’s it, folks. The five relationship rules that have literally changed my life and my relationships. I hope it’s helpful. It is a beautiful day to do hard things, and I will see you next week.

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